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Podcast Episodes

The Juicebox Podcast is from the writer of the popular diabetes parenting blog Arden's Day and the award winning parenting memoir, 'Life Is Short, Laundry Is Eternal: Confessions of a Stay-At-Home Dad'. Hosted by Scott Benner, the show features intimate conversations of living and parenting with type I diabetes.

Filtering by Category: Coronavirus

#318 Sarah has Coronavirus and Type 1 Diabetes

Scott Benner

Working at a NYC Hospital with Type 1 Diabetes

Sarah, ACAGNP-BC CCRN CCTN. Sarah is working in a New York City hospital, she's had Covid-19, has Type 1 Diabetes and she's on the show to share her experiences.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon AlexaGoogle Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

+ Click for EPISODE TRANSCRIPT


DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:06
Hello everyone and welcome to Episode 318 of the Juicebox Podcast. Today's show is sponsored by Omni pod Dexcom. The Contour Next One blood glucose meter and touched by type one.

Sarah 0:26
I'm Sarah. I'm a 37 year old nurse practitioner who works in New York, which is now kind of the epicenter of Coronavirus. I have two little kids, a five year old and a seven and a half year old boy and I'm married and my husband's a teacher.

Scott Benner 0:50
Sarah reached out to me just the other day wanting to share her experience as a healthcare worker in New York City who's recently been diagnosed with COVID-19. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any decisions about the Coronavirus becoming bold with insulin. Just about anything else. This is just a podcast. Talk to a doctor.

You can get an absolutely free no obligation demo of the Omni pod tubeless insulin pump by going to my Omni pod.com forward slash juice box. Find out today about the Dexcom g six continuous glucose monitor@dexcom.com forward slash juice box and to see if you're eligible for an absolutely free Contour Next One blood glucose meter go to Contour Next one.com to check out the world's most delightful Type One Diabetes organization and the whole of the world at least as far as I've seen. Touched by type one.org. How old were you when you were diagnosed with Type 117?

You've been doing this for a while?

Sarah 2:11
Yeah, I've been around the block a few times. 20 years? Actually, it just was my diversity this week, actually. Oh, well. Congratulations.

Unknown Speaker 2:19
Yeah. big week for you, huh?

Unknown Speaker 2:22
Yeah. Yeah.

Scott Benner 2:24
How long have you been listening to the podcast?

Sarah 2:27
Um, not that long, maybe four months ish. But I like what I tend to do with a lot of podcast is I kind of Bolus a lot of shows. I'm like, oh, wow, this is really great. He's got a lot of great ideas. And I like the way he thinks about things. And you know, I really like some of your guests and stuff. So I listened to a bunch like for a few weeks straight. So I don't know how I would say I've probably listened to about maybe 100 of your podcasts

Unknown Speaker 2:56
like you just just just a small number. Keep going.

Scott Benner 3:01
I'll tell you the the interesting thing that you're seeing around Coronavirus is that people aren't commuting as much and when they don't commute and listen to their podcasts as much. So yeah, I need this Coronavirus thing to be over just like everybody else. But not as much as you need it to be over. So I got a note from you the other day. And you said hey, I have type one diabetes, and I have the coronavirus. And I was like you're getting right on the podcast.

Sarah 3:32
I was I'm thinking about I'm saying something to you about it. And then when you I listened to your one that you talk to Jenny and you were joking with her like, Hey, can you just get Coronavirus so we can talk about it on the podcast. I was like, Oh my god, I have to message

Scott Benner 3:49
you believe she wasn't willing. Honestly. I mean, what kind of a person wouldn't just you know, risk their own death. So I can get a couple extra downloads on one, one episode of a podcast. No, I just really listen. I mean, I really was hoping to get some insight. So So let's do this first. So you you work in a hospital right? Are you in a but yes. Tell me what department is you work in? Is that?

Sarah 4:12
Yeah, yeah. transplant.

Scott Benner 4:15
Okay, so that seems like a place where you wouldn't want anybody to be sick?

Sarah 4:19
Yeah. Yeah, no, our patients are immunosuppressed. So they're actually more at risk of getting the virus. Mm hmm. Then, then even I am. So you know, obviously if you're type one, you're immunocompromised. But we give these patients medications that suppress their immune system. Right.

Scott Benner 4:40
So, so I guess the The question is, do you have a feeling for the epidemiology of like, how you like, you know how you got sick or is it just were you just waiting?

Sarah 4:51
Yes, it was either a co worker or a patient.

Scott Benner 4:58
One of your direct patients

Sarah 5:00
Yes, yeah. So I was, it was it was right before everything got really crazy with everybody being isolated and stuff. Yeah. And we were kind of doing business as normal ish. And then my coworker left work early, had a fever. And then I was going to go on vacation. My husband was going to leave the country. He was going to chaperone a trip but then that got cancelled because of coronavirus. And then so I was home and he was home. So I wasn't even scheduled to go back to work. And then I started feeling a little funny, a little sick, like I had congestion. But then he was complaining that he felt like he had the flu. Now, I've never had any flow. To my knowledge. I could have had it and just not had it. known that I had it. But I've never had like aches, I probably haven't had a fever since the 90s. Like, that's just I'm not I don't get a lot of colds.

Scott Benner 6:02
I haven't thrown up in three decades. So some point you're just like, hey, this doesn't happen to me anymore.

Sarah 6:08
Yeah, I do throw up a lot. Not a lot. But when I was pregnant, it was like, I was like, 30 something weeks pregnant. If I didn't have food on my stomach, I would drop so I do I do tend to vomit but like no fever is never anything I have had in fairness, sir. I've never been pregnant so I can't

Scott Benner 6:27
get apples to apples this with you. So you start not feeling well. Like how so? Today's March 28. How long ago was that? Do you think?

Sarah 6:37
I can give you the dates because I actually had to replicate the dates for a public health nurse called me the day after I was diagnosed. So this was um, I started feeling on well, March 15. But I thought maybe I had a cold. I was there. Last thing on my, in my brain was Coronavirus, because I wasn't really suspicious when the coworker left work. I just didn't really like oh, no, you know, he's probably just had some flu or something because it wasn't a big thing. And they we weren't allowed. I think it wasn't a big thing because nobody was allowed to test anyone. I mean, Trump had I think at that point had just come out and said, Oh, anyone could get tested. But no one could get tested. We couldn't test anyone. It was still I didn't really think people really had it. I mean, I thought it was coming. But I didn't think that it was like pervasive. So I would say Sunday night I felt sick Monday morning. I was like, wow, I have a horrible headache. It feels like I'm getting a sinus infection. I've had a couple of those like I'm over a decade ago. They required an antibiotic. So my husband goes to the pharmacy, he picks up an antibiotic, I have it at home. And I'm just feel like a little a little tired. I felt I had the headache. And then I felt like I couldn't really smell like my sinuses were blocked up hence why I thought I was getting a sinus infection. And then the next day, my husband's like, Oh, I feel worse. And he calls to try to get tested for coronavirus because he's like, I feel like I have the flu. But we all in my house, I'll get the flu shot because I'm type one. I'm a health care provider, we have little kids, we all get the flu shot like immediately when it's offered. We're very vigilant about it. So I honestly, like I'm not that you can't get the flu once you have the flu shot, but it you know, it's much, much less likely. So. So Tim was like, I think I might have it I'm like, I don't know, like maybe but that seems kind of far fetched. But it's all over the news. So like, yeah, that's what, you know, a lot of people jump to, but I'm like, I don't think so. So he calls and they're like, No way because you're too healthy to get tested. You know, he's not short of breath. He just has he had like a subjective fever, which kind of means he had chills and felt like he was you know, having trouble regulating his temperature, and just fatigue like, you know, low energy, they wouldn't test them. And then that night after he had called somebody texted me from work that a patient tested positive.

Scott Benner 9:24
And then all of a sudden it feels very real.

Unknown Speaker 9:26
And this is then I'm like

Scott Benner 9:30
well, this is all really it's so funny how quickly things have moved. So you're describing basically 13 ish days ago. And it really is the night and day difference between what we are thinking of now and what we were thinking of back then back then it was just sort of like hey, it's overseas it'll probably get here we're not sure what's going to happen yet. And and it it just really ramped up so incredibly fast and I guess you can you really at one point when we look back and and pay attention Assuming it would have been here and just not as prevalent, weeks and weeks before we really were thinking about

Sarah 10:07
Oh, yeah, I definitely was, I mean, based on like, where our numbers are now, it was definitely circulating. And I'm sure people had it and just never knew that they did.

Scott Benner 10:16
Right. Oh, hundred percent. Yeah. Do you think you had that thing where you can't smell when you lose your sense of smell or taste?

Sarah 10:22
Oh, yeah, I have that. And that's, I still have that symptom. That's with you pretty much over the other other stuff. But I still have that. And that's actually kind of how much when I cemented that I diagnosed myself as having it was so like, the day after Tim couldn't get tested. Then the next day, I was like, Can you call them back, tell them that your wife was exposed, and they still would not test him. And then later on, I call my supervisor and she's like, I'm try you can do a telehealth visit. Okay, so that's a big thing now, in order to screen people for being tested, but also to see other doctors because we're not sending anybody to see doctors, because that's like a big risk. So, um, I, I saw a doctor online, and I kind of exaggerated my symptoms a little bit, because I was like, based on what I have, I don't think she's gonna test me. But at that point, I also thought maybe my coworker had it. Yeah, maybe because they left with a high fever. But then I also was like, I had a patient who I, you know, admitted to the hospital who tested positive. Tell me,

Scott Benner 11:39
let me jump in. Tell me your thoughts about wanting to get tested at that point. I mean, you, you figure you've got it. Right. You've been in contact with people had it? What did you just want to know? Like, what changes knowing to not knowing

Sarah 11:51
part of me wants just like the public health data, yeah, like capturing a positive. But being more careful about quarantine, because at that point, I've gone to the store a few times, like I've done stuff, or being just being more careful. And also, like not wanting to expose patients, because eventually I was going to have to go back to work. Right.

Scott Benner 12:17
So just having that answer maybe gets you. I mean, it should definitely get you out of work. Is that right?

Sarah 12:23
Well, we'll get to that.

Scott Benner 12:26
Okay. things a little so upside down. It doesn't matter if, if you've got Corona as long as you know how to be a nurse.

Unknown Speaker 12:33
Not

Unknown Speaker 12:34
not Yeah.

Sarah 12:36
So, um, so they still wouldn't test them. They said, if they knew I was positive, they would test them. I did. I talked to the doctor and I kind of told her I had a cough, which wasn't a straight out lie. I probably coughed a few times, but I didn't have a persistent cough at all. Okay. Nothing like they're talking about. I never had a fever. They still want to test him. But they put in an order for me. But then I had to set an appointment. They weren't they're not accepting walkins to get tested at my at my job. So I had to wait for five more days. For once you put in the order to even get testing well. Yeah,

Scott Benner 13:14
well, there's a test at that point. Right. Like they're,

Unknown Speaker 13:16
I think they weren't prevalent.

Scott Benner 13:18
There's a rapid test. I think that's just becoming available today. Is that right? Did you hear about that?

Sarah 13:24
Um, yes, I heard that there is a rapper, I was actually more interested in the I saw there was a I don't know when the blood test is coming up, but Saturn is going to be able to Yeah, yeah, I think that's gonna be really, really useful, both for people that are taking care of the patients and for the patients themselves. If that's what again, if that becomes like,

Scott Benner 13:50
widely available? Well, I think my wife keeps talking about that. She's like, I've just one day I want to find out if I've had it or not, because she's like, I swear I had it like a while ago. And before anybody was talking about it. I am looking at an article right now. Us approves Abbott Labs, five minute rapid Coronavirus test that was six hours ago, this story went up so Oh, wow. Yeah, so this just happened.

Sarah 14:14
When I did finally get tested it only it was a quick turnaround. It was only it resulted like six hours later. Okay. Which was nice.

Scott Benner 14:22
So I guess we have to talk about it. Is that image online? True, does that because that looks like there's a swab on the end of a long wooden stick that goes in through your nose and heads back towards the center of your brain?

Sarah 14:35
Oh, yeah. It's very, extremely uncomfortable. And they really have to turn it around. And that's where some people are, are falsely getting negatives to and that's another reason that it's good to have a blood test. Is this because

Scott Benner 14:50
being done right? Because

Sarah 14:51
Yeah, exactly. But you really have to like turn it around in there and it's very uncomfortable. So if so if if The nurses been properly trained. And that's all they're doing all day long, they're probably doing it right. But we have like any and every nurse in the hospital doing it. So they're not necessarily getting good samples all the time and not and I don't not blaming them, they have a million other things to do. Like if a nurse is just doing that all day long, she's getting good at it. And she's like dealing with the patient's discomfort, because like my eyes were watering, it was very uncomfortable.

Scott Benner 15:25
Again, I just the picture online makes it and there's a description that says, it goes back to being parallel with your ear or something like that. And I'm like, wait, why? Oh, yeah. Like, I don't want that. Please, please. No, but I do like the idea of knowing, too. I mean, obviously, the way the the numbers get skewed constantly, because everybody hasn't been tested. And I mean, do you think that from what you're seeing, is the rate of death going to continue to drop as we find more people have had it? And

Sarah 15:58
oh, yeah, like, I'm sure the the Yeah, the mortality rate would be less if you could actually capture like, more accurate numbers. Yeah.

Scott Benner 16:07
Well, okay, so are you still doing transplants at this point, or have has that stuff's been I guess that's not a elective that needs to be done when it needs to be done? Right.

Sarah 16:18
Um, I think I'm going to talk about it more generally, and not about my programs specifically, right. But I think everyone else is being much more careful about who they do it too. Because you're you're massively immuno suppressing people so much. So I think most programs are are way way, like, doing a lot less only if it's really urgent.

Scott Benner 16:43
So your husband has it, you have it, how do you stay away from your kids? What do you do in that situation? I'm

Sarah 16:48
pretty sure they have to, honestly because then, um, so then and all another clue, germane to to what we're talking about is my insulin requirements went up to

Scott Benner 17:01
Okay, so

Sarah 17:02
um, so that was another reason I thought that I had it not usually when I get colds it doesn't go up.

Scott Benner 17:08
Yeah, Ardennes doesn't Arden's usually goes down a little when she gets sick. But, um, but just something obviously, with your body changed, because you saw your insulin needs change at the same time.

Sarah 17:18
Yeah, diabetes gives you a window to certain things that the layman doesn't necessarily seem to see. Yeah.

Scott Benner 17:25
Because you

Sarah 17:26
can see different changes. So Mike, Mike, that was another kind of thing that muddy the water. My younger son had been sick for weeks. So I kind of thought maybe we had what he had, yeah, maybe we just have some kind of a cold and it's affecting us differently. But his his was like a runny nose, and a cough. But during this time, his cough was getting worse. And so bad, because at that point, he had been maybe sick for three weeks, so I actually had to take them to the pediatrician, right. And at that point, I wasn't tested yet when I took them to the pediatrician. And she basically was like, Oh, I could test him for it, but only a few were positive. And I'm like, Well, I have an appointment in a few days at my job like, you know, I can only control what I can control

Scott Benner 18:22
right? But I have

Unknown Speaker 18:25
Yeah, I just

Sarah 18:28
like I've never felt like this before in my life, but you know,

Scott Benner 18:31
and so having it is like what is it just like every other virus you've ever had, or is it different? How's it been affecting you?

Quick hitting ads. Today I want to remind you that the links to all of this sponsors are right there in the show notes of your podcast player. You can also find them at Juicebox podcast.com. And here they are in quick succession. To get an absolutely free no obligation demo of the Omni pod tubeless insulin pumps sent directly to you go to my Omni pod.com forward slash juice box. Now is no time to let up on your health. Check out the Dexcom g six continuous glucose monitor dexcom.com forward slash juice box and you're going to need an absolutely rock solid blood glucose meter to go with your gear and the one you want is the Contour Next One, you know where to get that at Contour Next one.com Juicebox Podcast is proudly sponsored by all of these wonderful devices and by touched by type one.org.

Having it is like what is it just like every other virus you've ever had or

Sarah 19:48
I would say I had more fatigue

and I don't usually have a blood sugar bomb and I was definitely a little more insulin resistant and And then not being able to smell at all, even when I felt like my nose, like I was maybe congested for three days. Yeah. And then then it went, the congestion went away. But I still couldn't smell and I still can't smell now. And that was actually I have an au pair that lives with me. And actually, when I said that one day, like, I was like, if you guys want to get takeout, that's fine. I sat at home, even though we were trying to be very careful about it. And I was like, I can't smell or taste anything. And he was like, Oh my gosh, that's what they're saying is a symptom of coronaviruses. You can't smell or taste. And that was when I was like, Oh my god, I have 100% habit.

Scott Benner 20:36
That's got to be like a baby to get the test. Right? That's a bad movie, right? Where if somebody turns you slowly and says on the news, they're saying that that's one. And you're like, Oh, I have that? Yeah. Have you freaked out at all? Or like, so you've been a nurse for a really long time, right?

Sarah 20:51
Yeah, I was a nurse for nine years. I've been an NP for five years. Okay.

Scott Benner 20:55
Okay. So you've got a lot of experience in this space. Is this unlike anything you've ever seen before? Or what does it kind of match up with? from your experience?

Sarah 21:06
From what I'm feeling? Or the pandemic?

Scott Benner 21:09
From the work side? Yeah, from what you're seeing in the hospital? Oh,

Sarah 21:11
no, this is way different than I've ever experienced.

Um, yeah, this is completely different.

Scott Benner 21:20
necessary, in your opinion?

Sarah 21:22
Oh, yeah. Because Because of just the amount of Yeah, the amount of people that are that are affected? Yeah. Like, like, they, you know, that's what everyone's talking about flattening the curve, because we there's just not enough ventilators or not enough beds in the hospital to take care of all the sick people, because because no one has any immunity, because like, you know, people have immunity to the flow. There's, there's no immunity to this. And it's,

Scott Benner 21:52
we're all overwhelming new thing for the very first time all together. And yeah, it's moving, is it? It's moving more quickly than we see with other viruses. But that's, we're not sure if that's because none of us are immune to it, or if it's because it has an ability to move more quickly. But it doesn't really matter why. It's just it's spreading. so incredibly fast. Yeah. And, and so when we're all hearing in the media, we take in, that this is about spreading out people's illness so that hospitals can handle it. That really is though the entirety of the goal here, right? Like it's not, we don't think some of us aren't going to get it like we're all going to get it at some point in the next year or so. I'm imagining, you know, by all I mean, a lot of people are going to have it to varying degrees. What is the varying degrees? What are you seeing, like, what would you call your case of it? Like in the mild, mid and harsh like,

Sarah 22:49
I wouldn't say I'm a symptomatic for sure. But I would say definitely mild to very mild, because because I was feeling so low energy and I like working out. I was, you know, lifting weights and stuff at home like I was doing my normal thing I except i was i was just, I could fall asleep in the afternoon and I'm not usually like, I can't usually take naps and stuff. I just would wake up I would drink coffee and it was like I didn't drink any I didn't have any caffeine like like I was just I was very low energy. So my body was definitely fighting something. And the headache Oh, that was another thing that headache. I could Tylenol. And Advil didn't do anything for the headache.

Scott Benner 23:35
What did finally drinking?

Unknown Speaker 23:37
No, no. What did you

Scott Benner 23:40
were you able to alleviate the headache or no?

Unknown Speaker 23:43
I'm

Scott Benner 23:44
not really how long did it stay with you? Or is it still with you?

Sarah 23:49
I would say I had maybe like a two out of 10 headache today. But at the worst I probably it wasn't like severe severe because I've had migraines before this was like maybe a six seven but the fact that like normal pain medicine didn't do anything it was it was pretty obnoxious. Yeah. Luckily, I was at home for a long time.

Scott Benner 24:10
What about at work right now? Are they just using? Is it all hands on deck like Howard? How is this being staffed and and handled?

Sarah 24:19
Well, if you're too sick to work, you're too sick to work. And but you're allowed to come in if you have

seven days after your onset of symptoms,

which I was out of that window when my vacation was over. And honestly I didn't know that I had it when the first day I came back to work was when my appointment was Yeah. So I walked into work and I'm like, I'm pretty sure I have it but we have to get you know, I don't know that I have it. And I wasn't you know, I don't have the fever or the cough so I wasn't like you know having the big name symptoms. So I came back to work, I tested positive and I got the result as I'm walking in my door at night. But I was already out of the window. And the next day we like called everyone to make sure it was okay for me to work, you know, from occupational health to various doctor, you know, infectious disease experts to make sure it was okay. But their policy right now is either 72 hours after your last fever, or after seven days of when your symptoms started, you can go to work, I'm extra careful. Like I really, you know, mask and hand hygiene very, very meticulously, and I and and, and before this even happened, we were staying out of the rooms much more. Yeah, like we're limiting patient contact, worried about you know, getting whatever from them, but but actually more worried about us giving them something because there could be there. I'm sure there's many health care workers walking around with it, and they just don't have any symptoms, or their symptoms are so mild, they don't know. Sure.

Scott Benner 26:11
about you and your husband, like, it might be unfair. You've got a couple of little kids. So maybe you're not running around like smooching every time you see each other but are you like air high? fiving? Or like, what's your level of like intimacy, like, now that you cuz he's through it too, right?

Sarah 26:27
Um, yeah, yeah, he feel he feels 100% I wouldn't say I'm 100% like he had worse symptoms for a few days. But mine have symptoms have been milder, but more like, prolonged No, I didn't really, because I felt like I felt like the, the horse The, the horse was out of the gate. Like, I felt like I had given it to everyone already. Because we were all at home. I was cooking, like, you know, very cuddly with my kids. And I think also because once your, you know, your quarantine in your home. Anyway, I felt like I was more needy with like affection with my family, because I'm not seeing other human beings going anywhere Do you can't like touch anybody. So I felt like I had exposed everyone to it already. I mean, maybe like, I don't think I was sharing as much because I was, we were trying to do more like being a little more careful at home with cleaning, you know, washing things like I was having my kids do the chore of like, cleaning off the doorknobs with a Clorox wipe every day and the light switches, we were doing more like disinfecting at home. But like, honestly, after after I figured it out. Like I was like, it's it's already everybody I'm sure has been been exposed. I mean, maybe I'm being a little like blood about it. But I felt like I have already given it. So I didn't really change much. And it's very hard because my little kids are there not because we've tried to have them have better boundaries, especially the little one before, but he's very bad about it, he'll be very sick, have a cold and still want to kiss you on the lips and stuff. So I'm not very good about it's

Scott Benner 28:10
interesting because your human nature does take over. I mean, I've got two children and when they're sick, you, you do have that feeling like I'm gonna get sick, too. I guess it's okay. You know, like, you don't really stop from doing the things you'd normally do for them, like you don't like kick them into a room, like close the door and go listen, if you're still alive in five days, that'll be great. We'll come back and get a year in there helping them and you know, and doing what they do you have mountain. They're sitting on your lap and watching television. And

Sarah 28:37
well, I think also for Coronavirus, because I researched it enough to see that it doesn't seem like it's hurting children very much. And my children also, you know, they're very healthy. So I was like, I mean, parents overall aren't terribly concerned, I think about kids in general. But I think I was even like less concerned because I'm like, I'm the most immunocompromised person in my house. Like,

Scott Benner 29:02
why is the one concerned about me? Maybe Maybe I should be worried about Mila. But it's very interesting. I mean, the whole thing's really interesting. Because when you hear stuff like oh, you know, it's it's a it's a strange way to talk about it. When you hear them say, Oh, you know, it's mostly people who are older or compromised, you're like, well, that's not nice to say out loud. Because you know, there are people who are older and compromised who are listening to the news also. Yeah, that's not exciting news for them. What you just told them is 100% of you, you know, are having a hard go with this. And so I get what they're doing, trying to keep the masses to become, but then you will see like some I've seen a little kid have it and be on a ventilator already. And, you know, it's just like, I don't think this might be one of the very first times that as a nation, at the same time, we're all conscious of the idea of we don't want to get sick. And if you really look back at how you live, you don't live like that. You live knowing that you're You're gonna get a cold sometimes, or you're gonna have a virus or something's gonna happen to you. Like, I don't know that it's a reasonable expectation to live without being sick. I mean, it sounds pretty impossible to me. And so, like, where do you draw the line then? Like, you see, some people are, you know, on their boats, or there was just an arrest in New Jersey recently, where there was like, some, they somebody, like throw a house party and charged I think, admission, like turned it into a business. And and they got raided, and the guy who ran the party is being charged. And like, so, you know, don't do that, obviously. But like, Where's the line, like, we got food today, you know, like, brought in, and I broke the packaging down. You know, like, I was, like, I was on Breaking Bad. You know, I took everything out of the out of the bags of bags when the trash then you know, someone else brought me plates. You know, I put the food onto the plates. I threw away the packaging for food and everything and then wiped everything down afterwards and wash like 1000 times. And Kelly's looking at me like, what are you doing, man? Like, just relax? I'm like, I don't know, like I said, you know, we don't know where all these things came from. And I just don't want to be sick. Like it keeps for me coming back to. I don't want to end up in a hospital right now. Oh, yeah. Is that a smart thing for me to be thinking?

Sarah 31:16
No, for sure. And that's, that's the thing, even very healthy people are sick on ventilators. So it is it is reasonable for everyone to be extremely careful not only for to not spread it, but so you don't get sick because you don't know even though you have a healthy immune system, some people are just getting horribly sick. Like, yeah, my coworker that had it was way sicker than me and I'm the immunocompromised one. So it's, it's you don't know.

Scott Benner 31:44
Yeah, I think for me personally, in my mind, I'm a not wanting to end up in under medical care, while the hospitals are so taxed. Just because that just seems like you don't I mean, like, you know, if there's, if there's 10 nurses and 10 doctors and 50 patients, I don't feel like I'm gonna be getting like the hands on care I would be hoping for. Not that people wouldn't be doing your best but but it's stretched thin, you know. And then my next thought is, I don't want to be the person. Like, I don't want to live for the rest of my life knowing that like my neighbor's grandmother died and died. You know what I mean? Like for me? Yeah, like, because, because I had to what? kept Chinese food? Like, you know, you mean like that, you know, I that's the thing. And we've been, we've been in this house for like, two weeks now. And I have to be honest, I'm okay with it. Yeah, dude, but you know, and I'm lucky enough to be able to obviously do what I do from where I live, but it's not that bad. You know?

Sarah 32:45
Well, I think with the with the takeout. So for a while, I was resisting at trying to be so good. Well, it was first I felt like I was sick and like, I might have it. But then I also felt like I was scared that all these like local businesses. Were were under such duress that I'm like, oh, maybe we should order a couple.

Scott Benner 33:05
Here, right. You're also trying to support the because you're also looking at your own. But listen, you're still working. But there are people who aren't working people yeah. Backwards financially every day. And and then local businesses are anybody who's ever run a business knows that most of them are barely operating it even. You know, they have to keep moving to work. There are going to be places that don't open back up after something like this.

Unknown Speaker 33:28
Oh, yeah, for sure.

Scott Benner 33:29
It's just very, it's just it's different. I've never experienced anything like that. No,

Sarah 33:35
I yeah, I don't think this has ever been in our lives.

Scott Benner 33:38
Yeah. Now what we want Next, I'm assuming is we're hoping for inoculations for the future. But yeah, sort of similar to the to the flu vaccine? I don't know. But it's really crazy. So have you seen anything? Like, like if I said, you and I'm not asking you to but if I said you tell me a really scary story. You have one for something you've seen at work? Where what's your level of? Like, what do you

Sarah 34:06
um, well, like are specific.

Scott Benner 34:10
I'm just wondering if it's like it is.

Sarah 34:14
To me. Yeah. Yeah, it's it's sir. It's terrific. And I've seen a lot of stuff. I mean, I've seen a lot of awful awful things. You know, I've worked in an ICU I've seen some terrible things that like How can this happen to human beings, you know, people innocently going about their lives. But I yeah, I think what's most, like, hardest as like health care providers, I think sometimes is see because like, it's almost like an expectation to see older people that get really sick with something like this, or people that already have a few other conditions. Get very sick. It's I think it's the hardest when you see people like in their 20s knees, and they were completely fine. like walking around. And now they're like, in a terrible state, you know, they've got a machine for their lungs, they basically, you know, have machines working for the as their heart like, like, like, like horrible like they're next to death. And it feels that's that's the most terrific

Scott Benner 35:22
it is it is. It's how we all think. I mean, it's, you know, it's funny, it's wrong, but it is how we all think like, if you see an older guy, they've lived a pretty decent life, you know, like you, that's your brain and your brain writes

Sarah 35:34
it off. Yeah, but he's 70 something and, and passes away. Not that it's not sad. But like, oh, they've had a chance to live a life someone's in their 20s, you know, that they're just starting

Scott Benner 35:45
out. And so if that's what they're talking about, is happening to with care, right, like once we get down to rationing care. Oh, yeah. That's how those decisions then get made. Right? Is it by age? And hell? Yeah.

Sarah 35:58
Yeah, I actually read it because yeah, I had read about that happening in Italy. But I'm a co worker of mine sent an article about a new jersey hospital. Yeah. Um, I forget the name of the hospital, but it was the article was out there. But the The doctor was talking about already making the just like, the doctors were having to make the decision once the patient goes on the ventilator. Like if they don't look like they're gonna, you know, little while, like, if they don't think they're going to keep going and make it through this. They're just taking them off the ventilator to to sterilize it and give to another patient because it's not fair. You know, because in the ICU, we do incredibly extraordinary things. Every day, we have machines for almost every organ, it's requires a lot of money, a lot of personnel, but we can do and I've seen many, like people that were dead dead for like weeks come back to life. Yeah, honestly. But but there's not the time and the, the, the staff and the more importantly, the equipment to do that for everybody that you want to give a chance to. So the doctor was talking about, yeah, take it, if there's three patients that they took the ventilator away from, because they didn't think the patient was going to make it in the long run, and they couldn't give even give them in this situation now, like that's, that's the thought that you're not going to be able to give these people the chance. So, my job we're talking today about that similar kinds of things, like changing the way we make decisions, and healthcare.

Scott Benner 37:44
So it's, it's really the, it's the equivalent of a war movie, where you've seen where a medic comes along, looks at somebody and goes, he's not gonna make it. We're gonna go to the next one. But that's Yeah, but that person, you

Sarah 37:55
know, yeah. Really good synopsis. Yeah.

Scott Benner 37:57
Right. So you just sort of, you start making these decisions, and then Geez, that, then that has to weigh on, you know, that's not a decision you want to make you want to exhaust efforts. And then if someone passed, yes, right, but you don't want to exactly

Sarah 38:13
what we've been, we've been trained to do, right?

Scott Benner 38:15
Because what if you're wrong? What if you just look at somebody that one's not gonna make it will take the vent, get the vent clean, move it over to this person who we know with events going to do? Well, and, and you're wrong about that? And that's

Sarah 38:28
because you could, you could pick the other person and they might end up passing away in the end?

Scott Benner 38:33
Yeah, it's just their decisions that no one should have to make. And in, in my right to say, in the regular course of medicine, these decisions don't normally have to get made.

Sarah 38:42
Yeah, exactly. They, they don't and I actually have been talking about it, because I thought about it in the past week that like, honestly, a lot of us are going to need some mental health, like support. Because this isn't like the normal, like even the way the units are set up and stuff. Like wait because no visitors are allowed. Or the patients are lonely, if they're, you know, because not all patients are like out of it on a ventilator. There's, there's a lot of like patients that know what's going on in their family can't see them. Like it's a very, it's I want to dystopian, like the hospitals like a dystopian, like, please, because it doesn't seem like this isn't it's completely and there's so few people working they've minimized all the people working in the hospital. Like it's a very weird lonely

Scott Benner 39:34
place. Yeah, that fluorescent lighting is a little otter I would imagine today that it is normal, right? Yeah, just sort of feels like the fourth episode of a zombie television show. We're like everybody's like it's gonna be fine. Still, we're just working hard and we're gonna get past this. Except we except by the way, we are going to get past this it is going to like flattened out and it you know, people are still going to have it but it's, they're going to get to keep their event you know if they need one. Yeah, it's just this. This is the time this is the spiky time right now. And people are people are. I mean, we're not talking enough about the cases that have, you know, resolved and recovered. Yeah. And that's starting to happen. You know, we're starting to see those. I think the last numbers I saw, were like over 120,000 cases in the US, somewhere over 2000 deaths, but also somewhere over 3000 recovered. So, you know, that's hopefully the next bit of news we're going to start getting is, you know, how many of these, you know, I'd like to I'm excited for the day where it says, you know, we have 150,000 cases, and 100,000 of them have, you know, recovered already. And, yeah, so it's just a very, I don't know how you're doing it, honestly, are you? Did you say you're in a hotel right now?

Sarah 40:49
Well, um, they're doing a lot of things. I'm sure they're getting really good rates on hotels, because nobody's traveling,

Scott Benner 40:56
right.

Sarah 40:56
But they're also understanding that we, the commute, and everything is much more stressful, more difficult. And honestly, because every No, it's like, no one wants to take public transit. So the parking lot because I drove to work this past week was crazy to get it. I don't normally drive I usually take public transit. Yeah. But I think they're understanding that, you know, and also like, so then, they're also understand that people don't want to expose their family members, necessarily. So at least, like if you, you know, stay here and between and then if you want to kind of shower off, or I saw a lot of memes about like, nurses being like, I'm just gonna, you know, you're gonna see me stripped down to my underwear before I walk in my house. Just mind you're

Scott Benner 41:49
out front on the on the patio.

Sarah 41:51
Yeah, so so if that's the way you feel about it, like it's a safer place. I mean, I obviously I don't feel like I need to protect my, but it's nice to having like, to, to not have to somewhere you can

Scott Benner 42:03
go. I've heard stories of doctors sleeping in their cars at hospitals, because they don't want to go home. You know, so there's all levels of like, yeah, you don't want to like if you've got a family at home, and they're basically sheltered in place. And they're not ill, as a health care professional. You coming into the house is probably the worst thing that you can do. Yeah.

Sarah 42:24
Yeah. To expose everyone.

Scott Benner 42:26
Right? It really does make you think, doesn't it? Like what is expose everyone mean? Like, you don't mean? Like, you're just touching something like, you know, is it is it as weird as like, I touched the desk and a day and a half later, and my kid touch the desk? And

Sarah 42:40
well, yeah, this this disease is a lot of like, unknowns that everyone's scared about it, because I don't think a lot of it's not that clear. And everyone, stuff, policies and procedures keep changing. And the recommendations keep changing. So it's a very scary, it's a scary disease, because, you know, we've never dealt with this before.

Scott Benner 43:04
I'm finding it really fascinating to watch states that are, where we were two weeks ago, and how they're acting like, Oh, it's not gonna be that big of a deal. And I'm like, is it not like, you know, two weeks from now you're gonna be like, Oh, we should have done something, you know, like, just a very, because, listen, when this was all happening, I was in Florida with my son, and he was playing baseball, you know, he's a college student playing baseball, and we were like, hey, it's springtime, this is great. And then all the sudden, you know, there's these conversations about, hey, you're gonna get sent home from school, or, you know, spring breaks gonna get extended. And now he's, you know, now he's home for the rest of the semester. And my daughter's taking, you know, going to high school in my kitchen. And you know, like, that stuff two weeks ago was just things people were talking about, like, have you heard this might happen? And so I think you're right, there's just not enough. I think there's not enough top down. Leadership, like, like, somebody just needs to say like, these are the rules. Everybody follow them? You know, it seems to me that if we all just started doing the same thing two weeks ago, we'd all be a lot closer to it.

Sarah 44:13
Yeah. Yeah, we'd be in a much better place. But yeah, it didn't come it didn't come from the top because, I mean, the President had different ideas about it from long ago, right.

Scott Benner 44:24
I'm seeing here there's er workers are saying that a quote every man for themselves atmosphere, regarding their protective equipment has kind of like crept into New York City, sort of like you're on your own to protect yourself because we're out of stuff.

Sarah 44:39
Well, yeah, there there's there's a limited supply. I mean, my my hospital definitely has a good amount, but because the amount of patience and like we're going to be expected to go so far above like our normal capacity. I don't know if you saw government Cuomo talking about how we have to increase the capacity. So every hospital has to increase the capacity. So even if you were prepared for the amount of people you have, so many people are on isolation, like it's like an obscene number. So if you're taking care of the, we call them COVID patients, they have a lot of protective gear. But if you're not, you're basically in your limb, you're limited. you're limited to what? They give us some, but you're, it's it's kind of, you have to make it last.

Scott Benner 45:39
So like, if I'm delivering a baby, do I just pull my T shirt up over my nose? Is that? not quite there yet? But, but so you might. So there's a there's a descending order where the gears going?

Sarah 45:51
Yeah, for sure, though, there's, they have like a lot for the COVID patients, but for the rats, but at the same time, the problem is, sometimes you don't like, you know, we've been talking about you don't always know when people have it or not. Yeah. So like, like, you could walk into a room, you know, like I did a few weeks ago, like, not knowing that the patient had it.

Scott Benner 46:15
And that's it. And that's why the I mean, the tellement stuff for other stuff, you know, out in the world. Pediatricians visits, my wife isn't feeling well with something. It's not this. And she did. You know, she had a phone call with a doctor that ended in a prescription. And you know, a month ago, you would have been like, Really? That's weird. But that because that's not really something you ever think of is a doctor, like writing a script from your description over the phone? Yeah, but it was, I guess it's a better decision than asking her to come somewhere.

Sarah 46:43
Oh, yeah, for sure. Yeah, my endocrinologist who called me because she got routed my COVID result. And she's like, Oh, yeah, we're gonna do telemedicine and you'll just upload all your stuff and all that I'm like, Yeah. Okay. I guess. I guess it makes sense. Yeah. Although for me, it doesn't really matter.

Scott Benner 47:04
Yeah, well, for you personally, it's interesting, because you have for you personally, doesn't matter. You've had it already. Yeah. And you can't get it again. We should all get like tea. Everyone should get a T shirt who's had it? like, yo, don't worry about me. I'm good, baby.

Sarah 47:21
Well, that's what that was the other reason I want Well, my husband especially wanted to get tested because he felt like, I want to get tested. Because I want to know if in like a few weeks, I can help people if they need help, like if they need groceries or something and I don't have to worry about getting the virus. Mm hmm.

Scott Benner 47:37
I'll tell you the one thing that talking to you makes me feel exceptionally good about is it no matter what I do all these articles and I've had a doctor on already, Jenny's come on and talked about it, you know, and now having you on who has it, and obviously you're doing fine. Not that everybody's gonna have the same experience you're having with it, but it makes me feel better, because there's so many of these articles that are popping up about like, you know, COVID-19 and diabetes, like what should you do? And after you go through, you know, 2000 words, there's always an overview at the end it says so, basically, you know, wash your hands and stay away from sick people and like, clickbait more clickbait, you don't mean like, like, just what a horrible thing to do, like drive people because, I mean, you've had it now you have diabetes, you've been a nurse, you're an MP like, what should people in your opinion with diabetes be doing right now? anything different than anyone else?

Sarah 48:30
So when I was starting to like,

kind of become real, I guess sort of like the end of February when really we should have like started the lockdown. But like things were coming down that soon, you know, Italy was like, saying all kinds of stuff. Now I have like, pretty well controlled, not art and well controlled, but you know, my a one season that the six is, um, and I was like, you know, I think I'm gonna you know, step it up a little bit. Work, get myself a little tighter, and eat healthier, more fruits and vegetables. I've been kind of doing like, vegetarian since January. But I was like, you know, less dairy more fruits and veggies like I was trying because I know I'm immunocompromised and I do work in the medical field to be even more vigilant with being healthy. Right. So that was my biggest intervention. It wasn't like, I didn't buy to be fair. I'm like a mild hoarder at baseline. So in my basement, I already had like, one and a half big things of hand sanitizer. I had some wipes. I had I had enough stuff while but Well, a lot of people were starting to hoard things. I was trying to like, make myself help, like, follow a healthier diet, right? Pay more attention to my blood sugar's that's what I was trying. So while everyone

Scott Benner 49:53
else was looking for hand sanitizer, you're like, I'm gonna have an extra fruit and a sit up here. Yeah, by the way. Line mild hoarder is the T shirt, in case you're wondering. I don't have the time or energy to put that dope fact, but I feel like that is gonna be a big seller in the coming days. Yeah, it's uh, I mean, I threw a couple custom meat in the freezer, and I'm usually more of let's just waiting by it fresh kind of person. But you just thought, you know, listen, the one thing I did while you were doing a sit up is I was refilling ardens prescriptions in February, like I was I was paying attention to what was happening overseas. And I looked at all of our scripts and anything that had a refill available I sent in, I was just like, okay, I'll take more insulin, I'll take more insulin pumps, I'll take anything that you're willing to give me. I'll take right now.

Sarah 50:42
Well, let's be also because I'm a mild hoarder that I have 30 vials of insulin in my refrigerator. I have I have so much pump sites, I have like two insulin pumps. I'm wearing a Medtronic sensor, but I have a Dexcom in the basement that I need to switch over to so I have like, I have excessive diabetes supplies. I mean, I think because I've always tried to, you know, get my get prescribed more, etc, that I've just ended up with,

Scott Benner 51:14
I don't know, extras. On every time I just was like, I don't know, I thought I don't want to need this. Like, I don't know what's going to happen. Like, I didn't know how Cisco knows

Sarah 51:24
for sure. And if you don't have like a ton of stuff. Yeah, definitely. But because I i've always I've just had a CAD an excess of stuff for a while now. I don't know if it's just because I am not using as much and then you keep getting it. You know, I've I've been on an insulin pump for 17 years. So like, you know, I kind of stayed ahead of the curve. And I've had, like, you know, you guys talk about sometimes people like, you know, going between insurances, or they just don't have good coverage. But I've always and that's I think part of the reason Honestly, I went in to the nursing profession having diabetes, because I always knew that I needed really good employment to buy my supplies and good insurance and stuff.

Scott Benner 52:06
So having diabetes made you think I need a really stable job that comes with health insurance?

Sarah 52:10
Yeah, it did. Honestly, I do think it really affected the ways I was thinking about professions.

Scott Benner 52:19
I can imagine I mean it. I don't you know, I don't pressure Arden about it. But every once in a while, I'll be like, hey, see how we all have stuff for you see mom's job? You know, oh, yeah. As you know, everybody needs a job with insurance. I know you have dreams that are nice. I don't want you to not them. You know, don't forget your dreams. But don't forget, you need insulin too. And I'm looking at me, there's no way I'm gonna stay alive much longer. So I'm doing my best here. But I mean, let's be honest, I'm not going to be 95 while you're 40. So, pull it together, do your best. I think it's um, I don't think it's unreasonable to consider, you know what I mean? Like, I think it's smart to think about it. But that's what I did. I was just like, Alright, let me get these. And don't get me wrong. I wasn't hoarding stuff. I was just like, Look, we have prescriptions there up to be refilled, I'm going to refill them now. Because, you know, it's easy to be like, Oh, it's all gonna be fine. And it probably is all gonna be fine. But I just didn't want to get in the situation where Arden needed something. And that company got hit with this virus and got slowed down even, you know what I mean? Like, whatever it was gonna be. I just didn't want that to happen.

Sarah 53:30
Actually, there was an article written because a friend of mine shared it with me, it was a type one diabetic, who, I don't think they I know, I don't know what their job was, I think it was in business, but they wrote it like a, you know, an op ed piece on the wall street journal or something, but talking about how this might affect their disease, because the supply chain might be affected somehow. So it's a big thing to consider, for sure.

Scott Benner 53:57
It probably won't happen. But if it does, it does. And then what are you gonna do? Who are you going to call like, you know, world where you we all basically live a life or anything you need, you can have almost instantaneously, right? Yeah. So all the sudden, you know, what does it mean? If somebody tells you, hey, we're gonna get those to you, but it's gonna be a month from now. You know, here's a bag of needles and a vial of insulin, like good luck. You know, so a lot of us, you know, Arden definitely included. She leans heavily on, on the technology she has, and so she, you know, she needs to stuff to make it go. I don't think we could not do it the other way. I'm, you know, I'm pretty sure that what I, I think I could reverse engineer my knowledge back to MDI pretty easily. But still, it's, you know, no one's looking for that. And I'll tell you what, it would be like getting diagnosed all over again for Arden. Oh, yeah. You know, because she doesn't have any recollection of getting shots. So it would definitely be an on though and so I just thought all right. Let me let me be And, and I did the same not with food like we didn't like, you know we only have a basic refrigerator. It's I don't have like a, you know, I don't have three freezers in my basement or something. You know,

Sarah 55:13
I only I have one deep chest freezer in the basement.

Scott Benner 55:16
See? Well, you are a mild hoarder, then. Congratulations. What's

Sarah 55:21
that one? I know when I was breastfeeding my kids, and like my, my, my refrigerator freezer and my kitchen isn't very big. It can't fit like a very big refrigerator. It's like, it's okay size. But like if you're storing up a bunch of breast milk, so go back to work. This is probably TMI. Not at all.

Scott Benner 55:40
We can hear next week's episode about sex from a female perspective. This is not gonna be too much information good.

Sarah 55:46
No. So like, in a depressed freezer. Breast milk last longer. Yeah. Okay, so I think I got that. I think that my first kid. Yeah, just so I could store more breast milk longer.

Scott Benner 55:59
Gotcha. Oh, that that's a that's a good idea. I mean, now I'm trying to imagine how much breast milk you can pump. But that's a complete we're getting off topic now. Because that seems like a massive amount. But that seems like a really important reason to have one because Kelly's like, should we have one of those freezers? And I was like, I heard they use a lot of electricity. And what exactly are we going to put in it? Five seconds after this is over? You know, what the, that made me feel like and I bet a lot of people feel this way. You know, when there's like a power outage. You know, ever since you know, we've had a couple of hurricanes. Oh,

Sarah 56:31
yes. Irene killed my basement right. And I left her Sandy too. So right which was also a mild emergency, but my my house was okay,

Scott Benner 56:39
but doesn't didn't Sandy make you feel like I should have a generator?

Sarah 56:44
Oh, yeah, we got one. I think we got one after Irene, though. Okay, because that hurt my house pretty bad.

Scott Benner 56:50
And so I had that same feeling. I should have a generator. My wife's like, we need a generator. But I resisted. I was like, we don't need a generator? We don't we definitely don't, unless we need one. But I think we're not going to be able to resist that idea. But this is so do you see? Have you heard what are people talking about? About how long? Like how long is this? Are we at the apex for the New York, New Jersey? Like area? Or is this not it yet?

Sarah 57:18
I don't think it is. Honestly, I might be being a pessimist. But I would love to be proven wrong. I feel like it's gonna be like, another month or two, because the amount of people that have been diagnosed? I, I don't know, I can't imagine and some of these people need to be on ventilators for a very long time, right? I mean, if we get more ventilators honestly, if we don't get a lot of ventilator to

Scott Benner 57:45
go faster, right? Yeah, cuz

Sarah 57:48
not to be very morbid, but yeah, people won't live. But if we got a lot of ventilators, it's gonna last a long time, because some people like I have a good amount of ICU experience. Some people can exist on ventilators for a very long time,

Scott Benner 58:03
that could end up being necessary for some of them who are hit harder, because for you know, while most people are probably going to have your or your husband's experience, the people who have an opposite experience, it's an incredibly severe and dire experience.

Sarah 58:17
And it's I think it's much harder for people who have like a family member that's never been sick a day in their life to imagine like, I think, I think a lot of people who have chronic diseases or family with chronic diseases, you along the way kind of accept certain things. Like if you're like a realistic person, there's a, you know, I talked about it with people and like, like a knee jerk way, like, I could overdose on insulin someday, like, like, I have a more risk of dying than than the average person. And I think like, if you're a wise person, and you have family members with diseases, you think, oh, maybe they're, you know, they have more of a risk and I think they are more likely to be okay with the patient, you know, going passing away because they've dealt with a disease for a long time. But if you go in there and your husband's 40 years old, never been sick a day in his life, and you're like, do everything for them, like Like, there's no reason he's should be dying right now.

Scott Benner 59:26
It's the implications of your life, right? Like you have type one. So there's extra variables around your life. So yeah, sure, right. And, and 65 year old, 75 year old person in a normal everyday setting doesn't have the same implications that they do now that this virus exists. Now they're Oh, yeah, they're, you know, their context is different now. It's a very strange thing to hear. I think that's where some of this consternation is coming from right is that we don't really talk about dying like this ever. We don't talk about About mortality we don't talk about we talk about health, like it's fixable. I know for sure my kids think that whatever goes wrong with them, someone will just fix. Like, again, most of us feel that way. Right? Like, what could what could happen to me until you know, until you get one of those things that nobody can fix? And then your understanding of the world changes. And yeah, you know, so we're just hoping that everybody can stay in their understanding where Oh, it all will work out fine. Like most of us get to live like that for a while. The lucky ones at least. Yeah, yeah, that's really crazy. I really appreciate you doing this. Did we not talk about anything that we should have talked about?

Unknown Speaker 1:00:40
Um,

Sarah 1:00:43
no, I think we did it. We covered my disease.

Scott Benner 1:00:51
By the way, is it a disease? I sometimes I hear people call it a disease, but it's a virus a virus. It is the COVID. Like, I don't understand, do you? Well, I

Sarah 1:01:00
consider it like an infectious disease. Okay.

Scott Benner 1:01:04
All right. Because I always wonder like, sometimes somebody calls a disease on television, and then sometimes they don't, I'm like, well is, is everyone, right? It's no one right. So I appreciate you doing this shark. Tank. Good luck with everything. Huge thanks to Sarah for coming on the show as a type one who's had the COVID-19 virus. Please remember that Sarah's experience with COVID-19 was her own and yours very well could be different. But I thought it would be incredibly comforting to hear from someone who had the mild symptoms that you hear about, maybe not frequently enough on the news. Huge thanks to Omni pod Dexcom. The Contour Next One blood glucose meter, and of course, touched by type one for sponsoring the show. And how about a shout out to Sydney for refreshing all the music that you hear on the Juicebox Podcast. That's right, while the rest of these podcasts are circling the wagons going, Oh, I don't know what to do. Nobody's commuting anymore and listening to my podcast. I'll probably just put out some real short episodes, you know, to make it look like I'm putting out a show. But I'm really not that Juicebox Podcast is coming through with absolutely new music, all new content up to the date information. And next week, we're going to talk about working with Type One Diabetes from an adult female perspective. Please don't let your kids listen to that one. You know what, since you're here and basically the rest of your day consists of leaning on the kitchen counter wondering what time to go to bed. Why don't we listen to all the new music together uninterrupted like thank you so much Sydney, Mahler. your talents make this show amazingly better. Here's the refreshed theme.

Not all podcasts do this, but I put special music overtop of the ads so that you always know you're being sold to. You deserve to know that. And Sydney who by the way is 15 years old. I believe nine the first time she wrote the music for the show. updated the music too.

This last track was a surprise, I only asked Sydney to update the music that I had. But she even wrote a third piece that I love so much. I'm going to use it at the end of the show to use to hear the theme at the beginning of the theme at the end. Now you're gonna hear the theme at the beginning, the add music of the ads and this little ditty, as the show ends.

Okay, everybody do your best to stay. Well. I'll talk to you soon. Like I said, there's another episode coming in just a couple of days after dark episode about female sexuality. Dr. Edelman might be on pretty soon again to update us on the bigger picture around Corona. And there'll be some asks Scott and Jenny at the end of the week. Thank you so much for listening to the Juicebox Podcast, even during tough times.


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#315 Jenny Smith, CDE discusses Coronavirus

Scott Benner

Coronavirus disease (COVID-19): Juicebox Podcast conversation with Jenny Smith, CDE

Recorded March 20, 2020

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon AlexaGoogle Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

+ Click for EPISODE TRANSCRIPT


DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:07
Hello, everyone, welcome to Episode 315 of the Juicebox Podcast. Today's show was recorded on March 20. It is a conversation about Coronavirus with Jenny Smith. At the end of the episode, I've listed some important talking points from the CDC website. Make sure you get to those.

Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your health care plan, becoming bold with insulin, or anything else that might come up. You know what I mean? Jenny Smith is a registered and licensed dietitian, a certified diabetes educator, and a person who's been living with Type One Diabetes for over three decades. Jenny has the exact same person you hear on the diabetes pro tip series during the defining diabetes episodes. And of course, ask Scott and Jenny. Jenny works at integrated diabetes. And if you want to check her out, or even higher, you can do that. Jenny's email addresses right in the link of the show notes.

This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. The Contour Next One is without a doubt the finest most accurate blood glucose meter My daughter has ever used in the entire time she's had type one diabetes, go to Contour Next one.com to find out if you're eligible for an absolutely free meter today. The podcast is also sponsored by touched by type one. When you go to touch by type one.org, you're going to see an organization that is working towards a cure, supporting people with type one diabetes, and putting on maybe one of the greatest dance shows I've ever witnessed. Go find out more about them. They're supporting people with type one diabetes all over the world. You might be one of them, go check them out. And if you don't need that support, and you want to help support someone else, this is a great way. Touch by type one.org is a great way to do that. Get yourself an absolutely free no obligation demo of the Omni pod sent to your house today. Go to my Omni pod.com forward slash juice box. When you get there fill out a little bit of information. And on the pod is going to send you an absolutely free no obligation demo of the Omni pod. You'll be able to try it on wear and see what you think. And of course, find out more about the Dexcom g six continuous glucose monitor the exact same CGM that my daughter wears today. Go to dexcom.com Ford slash juice box. Let's get to the show.

Jennifer Smith, CDE 3:01
Hello. Hey, good morning.

How are you today? I'm

Scott Benner 3:06
we're hanging in there. How about you?

Jennifer Smith, CDE 3:09
Yeah, I'd call it the same. Oh, I would assume calls home from school.

Scott Benner 3:14
Yeah, we didn't even make it through. My gosh, we didn't even make it through is I'm

Jennifer Smith, CDE 3:23
sorry. I didn't realize I was all covered. A little post it notes.

Scott Benner 3:27
I don't want to know what you're doing with your computer in your private time. It's fine. So Cole was in Florida for his college tournament. He got there Friday. We got there Friday. On Sunday. He asked us for Azhar tech thinking that his allergies were coming on the runny nose. On Monday, he asked for another one. Kelly and Arden left on Monday to go home. I stayed behind Tuesday was his day off. And when I picked him up Tuesday, late Tuesday morning to take him to lunch. I was like, are you okay? And he's like now I don't feel right. And I was like, okay, so I took him out to eat. And he didn't look good. So I said hey, go back to my hotel and lay down for a while. So three hours later, he woke up. And he woke up to an email from his coach and said we're having an emergency meeting to talk about the season. So I had to hump him back like a half an hour to his hotel. He was feeling better from sleeping, but, you know, he didn't look magically better than me. Right. You know, and they announced that the season was going to be suspended. That's what they do at the time. And he definitely didn't feel well still. So now he's like ask me kind of like trying to be like, slides like I couldn't have the Coronavirus, right. And I was like, I mean you could you know I said you know what, what are your symptoms at that point he had a sore throat, a runny nose, you know Now you don't have a fever, you know. So, right. So the next day comes Wednesday, he ends up pitching his face off against the number one ranked team in the country. In Division Three, just pitches, these two amazing innings comes out of the game. The game ends, he gets on a bus and goes back to the hotel. I'm supposed to pick him up for dinner, he texts me, he goes, Hey, I'm not gonna go to dinner. But come over here. He's like, I felt like I was gonna throw up on the bus. And so I think he used every ounce of energy, everything he had, and realized that he was sick. So on the way over there, I just stopped at a like a Walgreens. I'm like, let me just get a thermometer. You know? Yeah, stuck the thermometer in his mouth. He must

Jennifer Smith, CDE 5:45
be a dad. Yeah.

Scott Benner 5:46
100.4. I took him right to urgent care. Oh, my God. Now he's an urgent care with a mask on. And they swap him for flu. He doesn't have the flu. And the guy looks at his throat and says, Listen, you have strap? I can see it. You know, he's like, I'm gonna give you a antibiotic. And I said, Are you gonna swap him for it? He goes, man, this is strep throat. And I was like, okay, you know, fingers crossed and all. But I took him out of the hotel where the kids were where the poor kid had to leave his team. Wow, I just basically like shudder, like, just yeah. And the he didn't play the rest of the week, obviously. But the antibiotics did it. That's right. He had strap. Yeah. So but you know, in the moment, it was weird. And when he went back to watch the games, like from outside of the dugout, and the last two days, people were, you know, they're like, hey, how's he doing? Like, you know, we just want to make sure it's all right. It really what they meant. No, they really meant was Hey, got strapped we took given authority has exactly what I was saying. Just like just like, oh my god, are you allowed out of your house? What's the Wisconsin thing so far?

Jennifer Smith, CDE 7:03
So the Wisconsin thing is beyond the like, multiple levels of weather we have happening, like it was raining before and now it's like, fuzzy snowing, sorry, I'm looking out my window. But being trapped in the house. No, I mean, we can go outside. Our kids are out of school. The governor originally had a timeline of like, on April 6, but just two days ago, no, two days ago, we got another email from our school district specifically stating that according to the new guidelines, school is delayed or cancelled indefinitely. We don't know which my husband and I are like, okay, that means that Oscar is just not going back to school this year. That's what I think we will be homeschooling and I mean, the The good thing is that, you know, working from home, I'm here right? But the bad thing is that working from home, I don't have a clinic to go to so I have work that continues which is very good. It's good that people can utilize this type of telemedicine to stay up especially as things change and things happen and there are more questions that come in. But it also makes navigating my day a little bit more interesting.

Scott Benner 8:22
Okay, we're talking about the Coronavirus today. So here is on the pods website if you want to know more about how they're handling Coronavirus. It's it my omnipod.com forward slash Coronavirus. So if you want to get a free no obligation demo, go to my Omni pod comm forward slash juice box but if you want to find out about the Coronavirus and how Omni pod is handling it, my omnipod.com forward slash Coronavirus there they will tell you how insulin is responding to the coronavirus outbreak. They're going to tell you if Coronavirus is impacting insolence ability to produce its products, what sterilization processes are in place to ensure the pods are safe. may talk about reordering. I'm gonna jump through it really quickly. insolate continues to be vigilant monitoring and managing the global impact of the coronavirus outbreak. So that's how they start to talk about their response. They say they also have a comprehensive plan in place to ensure the safety and well being of their employees and they are going to continue to deliver on the pods to those who depend on the product manager type one. At this time. insolate does not anticipate any product supply issues. Pretty cool here. They talk about the sterilization process. Why don't you go check it out if you're interested my omnipod.com Ford slash Coronavirus. Next thing I have to share with you is a lovely email that I got from Rick Doubleday. Rick is the chief Commercial Officer at Dexcom. rick sent me a note and said at this moment, there are not any interruptions to Dexcom his ability to produce and supply product. However, we do anticipate near term delays in both customer service and tech support as we transition more employees to a remote work environment. wait times on the phone will be much longer than usual. We ask that customers Please only contact Dexcom support for urgent requests at this time. Dexcom is committed to communicating with their customers as the situation evolves, and customers should visit dexcom.com forward slash Coronavirus for latest updates. So that's directly from Rick. Now, if you want to get an Dexcom system going go to dexcom.com, forward slash juicebox. If you're already using it, you want to know how Dexcom is reacting to the outbreak, check that out right there. Now, when you start looking around the internet for a little break from all this, go to touch by type one.org. There, you're going to find an organization with the mission to elevate awareness of type one diabetes, raise funds to find a cure and to inspire those with diabetes to thrive. They've got great programs and services, all kinds of stuff. And hopefully, I'll be there and may speaking, if you know, we're allowed to travel again and get together with people. But you know, that's a long way off, I have good feeling about that. Anyway, touched by type one.org. Check them out today. Last but not least Contour Next one.com. That's where you can check out the Contour. Next One blood glucose meter, there's a little yellow tab at the top it says get a free Contour Next One meter today, check that out, see if you're eligible. This meter also has a wonderful app that works both with Apple and Android really helps take your data to a new level. Contour Next one.com. All of these links can be found in your show notes at Juicebox. podcast.com. Alright, let's get back to Jenny.

Jennifer Smith, CDE 11:57
My husband is on medical family medical leave right now from his company. They allowed employees who have family members in home or whatnot that could be at increased risk to take their family medical leave. So he chose to do that. I mean, he sees thousands of people a day at work. And he was like, yeah, I'm

Unknown Speaker 12:16
just gonna be at home with you guys. So I'm sure companies looking for some people not

Scott Benner 12:19
to come in anyway. They're correct.

Jennifer Smith, CDE 12:21
Yeah, yeah, exactly. So you know, that kind of works out for whatever limited time he can use that for? I mean, he'll have to go back to work at some point. You know,

Scott Benner 12:34
we'll figure it out. We're gonna become a socialist nation pretty soon.

Unknown Speaker 12:37
Right? Well, yeah.

Jennifer Smith, CDE 12:39
But I mean, I'm, it's interesting, because, you know, grocery stores and everything, those things are still open. I expect for like limited time. I haven't really looked at the websites to see Are you still 24 hours? I would expect? Probably not. But yesterday, I thought, I got the brilliant idea from actually somebody I was working with. And she's like, Oh, I just, I just go online. And I just ordered all my food. And I just pick it up at the door. And I was like, why did I not think about? Oh, so I went online. And I did that, oh, the next time I could pick up groceries at the grocery store that we most often go to is Monday, March 30. Like, at 6pm. I'm like, I'm out of all of the fresh stuff that I eat every single day. I'm like, I'm not living just on like frozen broccoli. So we picked

Scott Benner 13:27
one person. So one of us goes to the grocery store. Nobody the other person's not going. Yeah, tomorrow, we're supposed to go move cold stuff out of the dorm. I don't even know if they're gonna let us do that. But wait and see. But no, I think this is going to go on for months. I don't think the kids are going back to school this year. And everybody is now seeing, you know, for all the things we talked about that are important. If you can't walk outside without getting sick, nothing else matters. You know, it's really, really something else there. I there's that one model out of England that says between 600,002 point 2 million Americans could die in the next year and a half or something like that, which is it's funny. It's a staggering number, right? And at the same time, my son said to me, because he's, you know, he's younger, and he doesn't feel like he's gonna get sick. Right? He goes, how many people die anyway. And I was like, what, just like before this and I said, about 150,000 people a day worldwide die every day. And he's like, so was 2 million a lot. And I said, it is if it's you. Yeah, you know, there's a way to look at the world personally. And there's a way to look at the world,

Jennifer Smith, CDE 14:40
you know, globally, globally. And yeah,

Scott Benner 14:42
there's two things are they're very different. So

Jennifer Smith, CDE 14:45
we are exactly I see no,

Scott Benner 14:47
I stopped my 20 year old son from going to play basketball. He's like, we're gonna go play basketball like you're not. Yeah, no, you're not PlayStation, that's your dream come true. You can play it as much as you want. So, um,

Jennifer Smith, CDE 15:01
we have everything closed. I mean, other than pharmacies and that kind of stuff. So yeah.

Scott Benner 15:06
Okay, so let me let me first talk with you about this. I think it's just important right now with the timing to put out an episode for as long as it needs to be if it's 10 minutes or half an hour or whatever it has to be talking about how to manage through a respiratory illness. Because, you know, it's gonna happen and we can at least have a baseline idea. We don't know what this you know, what do you call it? By the way, do you call it COVID-19? Or the Coronavirus when you're just chatting about it at home?

Jennifer Smith, CDE 15:35
I've just been calling it the Coronavirus because I just I feel like all of these extra like, names to things just it's confusing in my brain. So I'm like it's the Coronavirus whatever they want to call it beyond that. Fine. Right?

Scott Benner 15:48
We definitely go with Corona here. Because in the you know, in the monsters incorporated movie when the sock touches the thing, and they yell 2319 2319. So when people say COVID-19 Kelly, here's 2319. And it starts the whole comedy routine in the house. So we don't say that like that.

Jennifer Smith, CDE 16:06
That's funny.

Scott Benner 16:08
We go Coronavirus, though. So okay, so we don't see, I've seen I think two people with type one on social media who have had it so far, but haven't really heard much from them. We're starting, you know, you're you're not really hearing from people yet who have recovered from it. Because those recoveries have happened overseas, we're right, you know, we're, we're still in the spot where you're gonna see, I mean, today is the 20th of March, we had a big increase yesterday in diagnosis, and I'm gonna guess it's gonna double today, because we're now starting to see numbers from, you know, people who were tested five, 810 days ago, right. So there was

Jennifer Smith, CDE 16:50
a really good post done, and you might have read it, The Washington Post did a really good article that had graphical of dots interacting with each other, and how, like, you know, no social isolation versus minimal versus extreme socializing, isolation, and how much difference that makes, but you still get a blowout of people, it's just slower, and it decreases that, you know, that you graph essentially, of how many people will potentially get it, I think the problem will be until we have hopefully a vaccination for it at a small level, and I think this is why it draws out how many months we're going to see things closed, and social interaction minimized and things. Because until we have a vaccination, it's just going to keep floating around, just like somebody is always going to bump into somebody that bumps into somebody that bumps into somebody that hasn't had it yet. And you know, they don't, but that being new from everything that I've read, the human body doesn't know what to do with it really yet, or how to form like the antibodies and things that it would normally form for the typical cold and the typical flu and, oh, I see this again, I had this, you know, two years ago. Now I can handle it better again. Yeah. I think

Scott Benner 18:11
a lot of people mistakenly believe that it's gonna have a season like the flu. And it'll just we'll get to a date, and you just won't hear about it anymore. And that I think, listen, I don't know anything other than what I'm paying attention to. But I just had Dr. Adam Edelman on the show the other day, in this episode with us going to go up right after that. He talked, I brought up the Washington Post article, and before I could tell him, it was out of the Washington Post he was was that in the Washington Post? And I was like, yeah, we've all seen that. Right? Yeah. Because it's such a wonderful visual visualization of how you know, spread happens. But I would say, this is gonna last two full Corona seasons, whatever this time is going to be, and then I think there's going to be a break, and then I think it's gonna come around again. And then it'll probably be a normal part of life, like the flu, and, you know, write SARS and MERS, and all that other stuff. But it just spreads so much more quickly. And easily then things in the past have. And so you're just seeing it, overwhelm everything.

Jennifer Smith, CDE 19:13
Right. I think that in terms of, you know, diabetes, I think people with diabetes, or even people with other, like chronic health conditions, where they've become, it's become a habit to be more careful about things like, you know, you change your pump site, or you take an injection, you clean the site, you wash your hands, or, you know, maybe you wash your hands before you do a finger stick or you put your, your continuous monitor site on or those kinds of things. So we we already are a little bit ahead of the curve of just paying attention to hygiene is in it cautiously in that sense, you know, but then, in terms of just management, I mean, the only the only one that I read about online with type one specific was, as you mentioned a guy over In the UK, I believe he was from he had gone on a ski trip in like, December, December, early January or something with a group of friends. And a good majority of the group got have Corona or had Coronavirus. He himself got tested because others in his group, he was positive. And his symptoms actually didn't show up for several days after he was tested positive, and he has type one. And he actually, in his article, he mentioned the fact that it wasn't so much the diabetes management. That was the hard part about it. It was he described it as like uncontrollable respiratory coughing. He said it was just so unbelievable that the only thing that helped was some type of medication, his doctor prescribed him and he went and he picked up steps to stop the actual coughing, but he said otherwise. And of course, this is an end of one experience, right? Everybody's experience with an illness is a little bit different. But I think it gives, it gives good information that if you were fairly healthy outside of just your diabetes, and you have fairly good blood sugar control, which is a huge key in a lot of this, then your management strategy for the illness piece of it shouldn't be that much different. If anything, you're you're gonna likely need I mean, most people with a respiratory illness who have a fever, or an infection, you're going to increase your insulin use. So

Scott Benner 21:35
I Well, it's interesting, because obviously, we this is a new virus, you know, for us and no one's really seen it before, but I've been managing Arden's blood sugar in one way or another for I mean, over 13 years, it's probably coming up on 14 years pretty soon. Viruses don't really change her insulin needs greatly. Now, I've seen it differently for other people, you know, but I just don't see a mass difference. I have to share this somewhere. So I'm going to do it here. So Vicki's been on the show before she talked about eating. What's the thing when you don't have any carbs?

Unknown Speaker 22:15
I can't believe that we're just Oh, like ketogenic ketogenic she was she Yeah.

Scott Benner 22:18
Vicki was on to talk about that. She and I were speaking this past weekend about something different. And she said something just hilarious. She's like, I'm not afraid of this fires. She goes, my immune system has already killed my pancreas and my thyroid. It could take this, it could take this Coronavirus. No problem. I was like, oh, but I think a lot of people with type one feel that way too a little bit. Right. Like, I mean, it's not everybody, but you talked to a lot of people are like, I don't get sick that often. You know, like my immune system is really great. I'm incredibly healthy with the exception of the fact that my pancreas doesn't work,

Jennifer Smith, CDE 22:54
right. I mean, honestly, I was until I had kids who started going that well, one child who started going to school, I rarely had even the common winter cold rarely. But, you know, so and even from that standpoint, I would say when you talk about you know, Arden's insulin needs don't really change so significantly, everybody is a little bit different. And I think the other thing to consider is the severity of the illness. And what At what point you are in illness, right, because I know myself with just a typical cold like the sniffles I might feel a little under the weather. But other than that, I'm going about my normal daily I'm not laying in bed like blowing my nose like minute after minute after minute. That typical cold, I maybe need a little bit more insulin like maybe five or 10% more it's not even as significantly noticeable and if I can remain at least moderately active, I actually don't even notice a difference in my insulin needs. Whereas if I have a really nasty cold my insulin needs will go up 40% from a basal level to start with and then if my post meals still aren't I'll adjust my ratios too.

Scott Benner 24:09
And there are there are illnesses that Arden needs more insulin for sure. It's those ones that are just sort of like she's got a little cough or her throat a little sore or has a little stuffy those don't seem to hit her but when she if she gets like, you know, knocked over by an illness when the body aches stuff happens and when the right rundown thing happens then and then you start getting like you said you start moving around as much you're more dehydrated, like there's a lot of stuff that goes into that

Jennifer Smith, CDE 24:39
well and I think you bring up a good he said hydrated right? It's we've talked about hydration piece just in general before but we talked about a respiratory illness specifically. I'm sure we've all seen the mucin x commercials right it's a little like blob of like mucus like you know haha I'm like in Getting your logs in your nose, and I'm not gonna let you sleep kind of thing. One of the biggest things to do is stay hydrated more. So if you're the person who's like, I drink eight cups of water a day, or I have five water bottles or jugs of water a day, you know what double that, because that fluid will help to move things faster through the system and keep that stickiness down. From the mucus standpoint. Listen, in

Scott Benner 25:27
plain words, if you have fixed not, and you hydrate yourself more thiess not will get thinner.

Unknown Speaker 25:32
That's right.

Scott Benner 25:35
It's just, you know, it's not something that's it's hard to, it's not hard to follow, it's hard to drink the water when you don't feel well. Right. That's the whole thing. It's difficult to maintain these good practices, when you feel like a truck ran you over and then backed up to see what it hit. You know that that really is the problem.

Jennifer Smith, CDE 25:54
There are some other things that are even not like, pharmaceutical, but things. I think that the Tea Company traditional medicinals makes a tea it's called throat coat. There's another one that they make, it's called breathe easy. All of them, they work very well. I've used them in, you know, a respiratory kind of bugs. So beyond going to your local pharmacy and grabbing everything off of the shelf, some of those things to kind of have stocked in your cupboard as a backup, um, peppermint and ginger can help to ease if you've got some stomach discomfort from like, post nasal drip and that kind of stuff. So there are a lot of things that we can do chicken broth, vegetable broth, all of those. I mean, there are there's actually really good research even just into chicken noodle soup when you've got a respiratory illness and the benefit of what that actually does for the immune system. Yeah.

Scott Benner 26:46
Well, you know, it's interesting as this is also new, and I think that it's going to continue to feel new even when we get deeper into it. Just the other day. You know, there's a wash of an article about you can't take ibuprofen if you have the coronavirus, it makes it worse. And I was like Now hold on a second. What just happened here? Like Did you know I started thinking about the podcast a little bit. I was like somebody stuck a pencil in their pocket and robbed the bank and was like, I know what this pencil just made me do. You know? And so and then it didn't take long for I think who to come out and say that ibuprofen is not a problem to take with the Coronavirus, right. It is really one of the problems with with social media, is it just anybody really could say whatever they want it and you know, if a person sees it, and they're scared, you know, they go back. So it's funny, we talked I you know, I talked about having you on for this to talk about management during a respiratory illness. But I mean, what really changes in management? Not a whole lot, right?

Jennifer Smith, CDE 27:47
Not a whole lot, honestly, I mean, you it's an illness. And unless you have another background illness, such as, you know, lung diseases or you know, there are some people with type one who actually have type one because of something called cystic fibrosis, right, which is already a lung disorder. So someone like that would have much more different management needs, even outside of the blood sugar component to it. So but when we're talking just about diabetes management with a respiratory illness, there shouldn't be much that you don't know in your normal Sick Day. packet of no checkoff, I got this. I got this. I got this.

Scott Benner 28:30
So when this all started happening, I thought, I'll put let me put some information out there'll be helpful people, and it was great to talk to Adam because he really did go over what the Coronavirus is and what it is and all that stuff. But as we were talking, and as I've been thinking over the last number of days, I think the most important thing you can do about the Coronavirus whether you have type one diabetes or not is be healthy, right like just be as healthy as you can be because a healthy body does a better job of fighting off viruses, colds and all kinds of things. Rock so much like well, you know, we're all locked up inside. Go back to Episode 210 and start the pro tips over again. It means like like get your blood sugar lower, stable, take out the variability. you'll move around a little bit even though it's probably gonna be in your living room for a while. We're here

Jennifer Smith, CDE 29:24
by the way, we've got lots and lots of online videos now that are free workout options, even my gym my gym like stopped all of our memberships so that we would not like have to keep paying for something and not being able to go but they also sent out a connection link for 150 workouts online that are free for us to use, which I thought that was a really nice thing just from a gym standpoint to do for its members. Um, but their 10 minute workout their 30 minute workouts, there are a lot You've got some equipment at home, you could even use your peloton or whatever it is, you know. So

Scott Benner 30:05
I think it's it's stay moving, stay healthy don't fall into like really poor diet habits because you know, it's going to be easier. And I don't know how easy that's gonna be to maintain over time, I don't know how easy getting food is going to be weeks from now I'm sure it's gonna get a little dicey at some point. Maybe just because you're gonna be scared to go outside, I don't know. But I don't think if you're really paying attention to the day to day numbers, and not listening to political conversations around it, but actually seeing what, you know, the CDC is saying those kinds of things. We are, we are following the bend of that, that Italy was falling, like we're gonna get a really big spike. There are a lot more people here we are spread out further, we have population centers, not just one or two, like smaller countries, too. We have, you know, countless dozens of population centers. This is not ending anytime soon. You know, if I had to bet money, I'd bet my kids aren't going back to school this year. I bet that things are gonna change moving forward, even. Yeah, you might start seeing work from home days for school in the future. And, you know, I think the other thing that's gonna happen here is we're gonna learn a lot about things that we've been afraid to look at. So far, like telemedicine is such a god example, right? You guys, you guys have been, you know, who else is talking to people about their diabetes through, you know, through video interaction, except for you. And now suddenly, every doctor's office in the world is like, this is how you go to the doctor now. Right? Right. Okay, so I think you have type one. Are you doing anything differently? No,

Jennifer Smith, CDE 31:51
I really not. I mean, other than, I mean, in my diabetes management itself. No, I'm not. I mean, we have, you know, all of the Sick Day things in the cupboard that we could possibly need. I mean, we actually went about was like, two weeks ago, before any of these school cancellation and anything of that nature. I was in the aisle just picking up some band aids. And I was like, you know, let's just get some extra things. Just like I could see what was sort of like, coming down the line, right? So I got some extra, you know, like cough medicine and that kind of stuff, just to have got popsicles in the freezer. All that kind of stuff. But other than that, my normal management is it. I'm managing the same way. I'm trying to get exercise every day in my house, or going outside and taking a run with my dog or, you know, whatever. I know some communities even have some restrictions on that, but we don't right now. There are plenty of you. In fact, more people I think I've seen like, I have to get Brashear like, let me out of my house. Right. Fair.

Scott Benner 32:58
Two days ago, Colin, I went to an outdoor cage so he could hit Hmm. And afterwards, no lie. His personality was brighter. He had more energy. He was smiling. Like he just he's not a person who wants to be trapped and sitting around and you have to almost the same as you sometimes can get lulled into being like Oh, 150 is a good blood sugar. 180 is not bad. You know, 200 is not far from 150 you can start getting to the like, Well, you know, Doritos for lunch is fine. Today, three days a week with the Reno's isn't bad, you don't I mean, like I haven't moved around a month, but I've only gained six pounds like you can like

Jennifer Smith, CDE 33:35
you can write, you can sort

Scott Benner 33:37
of just know that and slide into it and not know that it's happening to you. And then by the time that happens, you know, you're having that conversation with yourself like ooh, I've let things get out of hand. And then it's harder to get back from.

Jennifer Smith, CDE 33:50
I do think too, within that. from a management standpoint, we do have to consider some some things that if and when you can get to the grocery store, right? Because you're probably not going every other day or every three days Oh, I just need to pick up the milk today or I just need to do is you're like okay, everything on my list I can get it and I hopefully this will be stockpiled for like two weeks before I have to go back you know running in and out again. So from the standpoint of diabetes management and then making sure your list is full of all those things that you know keep you in line and it might even come down to making some more soups or making some more things that do last a little bit longer. I mean I know fresh fruits and vegetables and we certainly we have to go shopping either today or tomorrow someone in our house you know myself or my husband has to go because we're out of those we've got some frozen stuff but other than that our fresh is gone and I I like living on my frat

Scott Benner 34:50
Yeah, well listen, I am so the the I'm one of those people who usually goes grocery shopping like every few days. I'd much rather like bang in and Because that's how I like to keep the food fresh in the house, you know, I don't want to grab, you know, a ton of vegetables I grab enough to get me through a couple days. That's obviously a little upside down right now and might not be going as well. The other day, we ate leftovers, that I think in a regular situation, I would have been like, you know what, let's toss these out and start over again. But I was like, No, eat this. You know, like, What's another? What's another meal? Like? Let's get another meal. And prior to all of this? I guess not really prior to it. Maybe I just paid attention to it a little sooner. I ordered everything that Arden had a refill for I refilled. I'm starting to think I should have gotten to see but to just in case. She you know, I don't know. I don't know what, just in case three months from now, you know, other stuff starts happening me Meanwhile, pump companies Dexcom they all say like, we don't see this affecting our supply. But what if it? What if it's not them? What if it's delivery? Or, you know, what if it's, what if it's FedEx or, you know, whatever it ends up being. So I got all of our supplies, restocked. And I buy these juice boxes online that come in a big flat, and I was like, I'm gonna get to them, like garden could get low, like, I don't know, 150 times that I'd be okay. Yeah, right. Right, which I don't think she'll get low because you

Jennifer Smith, CDE 36:24
also have a goose box that works very well for her. Yeah, others don't. So you know, what works. And, you know, you kind of stockpile put it away, I know, my my glucose tablets that I really like to use have been out of stock online for quite a while. And so when I went to pick up my last insulin fill at the pharmacy, I grabbed two bottles of the only kind of that pharmacy brand glucose tablet that doesn't have artificial colors or anything in it. I grabbed two of them. And I actually, if I don't hide them, my kids will eat them. Like lip height these way away. So nobody else knows where Jenny's supply. I think,

Scott Benner 37:05
you know, I am not an alarmist person at all. But and I think this is going to be fine. Like I think this is gonna be a natural, it's gonna run a natural course. People are going to die. It's not going to be pleasant. I think we're all going to know somebody who died from the coronavirus next year. But at the same time, I did say to Kelly last night, I was like, let's start thinking more long term around Arden. Like that was the only thing I've said about diabetes so far. Like, I don't know what that means. Exactly. But let's always be thinking months in advance, not days in advance about Arden. And she's like, okay, and I'm like, I'm not worried. I'm just thinking we should change our focus a little bit. Right. You know, I did my best the week or so ago, I put up on my social media. I was like, Listen, if you have refills, filled, do it now.

Jennifer Smith, CDE 37:51
Yeah, absolutely. I know. That's actually one of the things that I also went through even my husband who pretty much leaves my diabetes management to me, I mean, unless I'm like, I need help with this or, you know, can you pinch my skin back here to put the Dexcom in or whatever, for the most part, it's all my management but even came to me is like, sure you're okay, on all of your supplies. You got enough insulin, you got enough of your pods. You got enough, you know everything and I was like yeah, I'm, I'm really good for you know, he's like, how many months? Like, hi, at least four months? I'm pretty good before I'd have like even maybe more than that, quite honestly. The biggest one is sensors, because I can't get more sensors other than what my insurance will cover. Yeah, I can't. The one the one thing to my pump right now is that I'm I'm kind of training on the control like you with hand up. So right now my pads are not being used a little extra,

extra.

Scott Benner 38:58
He's like, I gotta figure this other pump out for my job. So my my pumps are sitting in a pile I'm not gonna use.

Unknown Speaker 39:03
That's right.

Jennifer Smith, CDE 39:04
My Riley link gets a little break. And

Scott Benner 39:06
it's funny. Yeah, yeah, little extra stuff here and there. You know, little stuff off to the side, if you can afford to grab it. It really does make you think about the people who can afford it who are paying cash, or just, you know, that horrible. It's got to be in the back of all of our heads somewhere, right that, you know, if I don't want to be like, I'm not a doom and gloom person. But I do think this and I thought this before Coronavirus society is a paper tiger. It really is just holding together because we all agree to let it hold together. Right? That, you know, I don't walk across the street with a bat, kick my neighbor's front door down and steal his television just because we've agreed basically not to do that. Right. Right. Right. And but you know, it's it's assumed that if you get sick you go to a doctor a doctor helps you even if you don't have insurance. Someone will help you right? Yeah. Now all of a sudden your doctors are like, Look, call us on the phone. Don't come here. You know, the grocery stores always got food right? Now, Wow, well again, but it doesn't right now. And it makes you think, like bigger picture, like would it make you realize is that 10 pretty smart people who were writers sat in a room one day and said, what would it be like if zombies came? And then they wrote what they thought would happen. And, you know, that's probably pretty close to what's gonna happen. You know, it's, it's just where human nature takes us in these situations. The toilet paper is a great example, right? People are afraid, what makes them feel better control. having enough toilet paper feels like control. It seems silly right now. But it's true, like, right, it gives you some feeling of control. I filled Arden's prescriptions and got more juice boxes, and I bought, you know, I got the G vote the kids, you know, like stuff like that, but, and that makes me feel like it's okay. And it is okay. Unless, you know, people just decide to be lunatics. And then I don't know what happens next, you know, and none of us do. And, and that's the real, that's scary for every living person. But more so for a person who has type one or has something else who is who is your ally is reliant on these things working on the on the traffic lights going on, when they say they're going to, you know that that stuff that we just take for granted. So the best thing you can do is be be prepared. And and do your best and not lose your mind. Right, you know, don't go Don't go barging through people's doors with the you know, the bat, right?

Jennifer Smith, CDE 41:45
Give me that. It's so funny.

Scott Benner 41:47
This must have been in the consciousness a month or so ago. Because Because Arden came up to me six weeks ago. And just out of the blue, she goes, Hey, the zombies come? What happens to me. And I was like, so

Jennifer Smith, CDE 42:06
just a random teenager kind of idea.

Scott Benner 42:08
And she wasn't really talking about zombies. She was like, Hey, you know, this stuff gets upside down. You know, with the diabetes, what happens? It's like the first time she ever asked, and I said, I said, well, in truth. I said, If things really got sideways, I guess I would throw my morals away, go down to the corner and overpower as many people as I could and take as much insulin as I could for you. If we're if we're into the apocalypse situation, if that's what you're talking about. I said we'd lower your carb intake, which I don't think would be trouble because I don't think we'd have food. Eventually you I tried to keep the insulin cold. you'd run out of it eventually. And she goes, how long? I'm like, you'd be dead a couple weeks, a month later, probably. And she goes, Okay, that's what I thought. And I was like, I right on. And then we just sort of like, walk around the room. Yeah, it just she she wanted to know. I don't think she'd ever said it out loud. I think she knew, but she never said out loud. Like, what happens if these mechanisms go away? For me? I was like, that's pretty much it. It's like some of the Egyptians stayed alive a really long time. I was like, Oh, yeah, I mean, if you How long do you think you could eat kale before you just gave up?

Jennifer Smith, CDE 43:23
There are lots of ways to cook kale. I like

Unknown Speaker 43:27
that, you know,

Jennifer Smith, CDE 43:28
the other. The other thing to possibly do is maybe you know, get your own pig farm started. And then directions about how to make your own insulin and your you know, pig farm out of the pigs that you're growing in your backyard. Or

Scott Benner 43:41
I'll tell you what, if that kids, if that kids hanging her hat on that on me figure that out, she's in trouble. I could maybe do a podcast about it, but I don't think anybody would care. Right? But anyway, like, I don't think of that as, like, I didn't think of that as a sad thing. She just wanted to understand her reality. She got to an age where she was like, hey, just real quick, like, you know, right? What, what is this about? And it's not something I was talking about. Maybe she was hearing something at school, or like, I don't know where it came from, honestly, but I wasn't gonna lie to her, you know, and I wasn't gonna just be like, that'll never happen. I mean,

Jennifer Smith, CDE 44:16
who knows? We don't know what the future is. in any circumstance. Even without this. We don't know what the future necessarily.

Scott Benner 44:23
And if it if it happens, you're not going to stop it. If it's happening. You know what I mean? Like, it's, you know, and I just I told her, I was like, Look, I said, She goes, do you think it'll happen? And I said, No. And she said, why I said, greed. She goes, what I'm like, we live in a capitalist society. Everybody wants things. The only way they get things is to go to work. They want to go to work, they want to make money, they want to have things. I was like, it's what keeps people chugging along. It's what keeps insulin being made. And insulin pumps being you know, people like they think there was a guy one day who was like, I could make a better insulin pump. I bet you I could do this without tubing and he made it and turn into a business. And it was like, that's what keeps society moving people's desire to do things have things be alive. You don't I mean, I was like everyone's desire to be alive is going to be why you're going to have insulin and pumps and needles and whatever else you need. And, and I said, so while I can, you know, I can think about your little scenario here that you've made up in your head. I don't believe that's gonna happen, you know? No. So we'll say even with this, it's gonna it's going to pass. There'll be a day in the future where you'll say to somebody, do you remember that Coronavirus thing? Wasn't that crazy?

Jennifer Smith, CDE 45:37
Right. Right, exactly. It's, you're right. You're right. But I you know, in terms of even like, your daughter's question, I think you also, you know, you kind of bring we've already talked about like the supply component. But the going back to like, the age old management strategy, like maybe your technology dies, and you can't get a replacement for it. Do you know what to do? To go back to an injection? Do you have pens? Do you have syringes? Do you have you know, your vials? Do you know how to use them? Do you know what your doses are? All of those things are, they should be in your marked down list of I would know how to do this. If this happened, or if this failed, I could go to this parameter. If this fail, I could go down to this like 1940s way of management.

Scott Benner 46:33
I thought about it last night, and we don't have slow acting insulin in the house. And I thought she'd get stuck a lot. But I could do it with just her pager. Like I know I could you know what I mean? Like it wouldn't be perfect. But it would be she'd be alive, he would be alive. Yeah, and in enough time to go get some slow insulin somewhere. Right. But I think I could do it, you know, it's just, you know, there's a certain I'm thinking, I would probably create layers with boluses, like rock, like like just, you know, put in a bolus. Think about where it peaks, probably right at the peak time, put in more and just keep those like dolphins like

Jennifer Smith, CDE 47:15
flying through the muck have to do your own little like graphical chart, I don't sit here it should be done here. I dusted here, it should be done here. We kind of have to keep track that way, mentally, to not drive yourself like insane with a charged brain. But in

Scott Benner 47:31
my mind, if I know when it goes in, I know when it peaks and I know when it crashes, then I can put the next one in and create them

Jennifer Smith, CDE 47:37
for next week at

Scott Benner 47:38
the crash and just keep the peaks covering the crashes. And that should make a reasonably level amount of insulin the whole time. So

Jennifer Smith, CDE 47:46
and that that would work for somebody who has looked at and truly understands the total action time of their rapid insulin. This podcast for a while you're right, you do and I would say you know Scott definitely could do that. If you've not really ever figured that out. probably

Scott Benner 48:05
thinking a lot of people might kill themselves doing it. Yeah, oh, this is definitely one of those episodes where nothing you hear on the Juicebox Podcast should be conservative. But But I was really that's what I was thinking. Right? Like, would there be a way to bump insulin and over and over again, so that she didn't find herself without insulin? Or didn't find herself with too much? Right then? I don't know. I think I could figure it out. But, you know, again, it's because I, I can be like, I can be dispassionate about it. It's not me if I had diabetes, this is what the sound sounds like, Jenny, I don't know what I would do. If I didn't have so I can answer I probably just run around the house, I hit a wall and just passed out, you know, like, so it's, it's an interesting thing when it's for someone else,

Jennifer Smith, CDE 48:48
because you can step back and you can look at it for a second.

Scott Benner 48:51
Wow. And you don't have that Panic of like that your health is on the line.

Jennifer Smith, CDE 48:55
But overall, you should run to the pharmacy. And you should get well Jenny,

Scott Benner 48:58
I'm gonna tell you what I'm gonna. I'm gonna send an email when we're done to Ardennes. And oh, and I'm going to ask for some slow acting insulin. There we go. And I guess maybe two, I don't have a backup. Yeah, that's exactly what I'm going to do. And that's what we should all be doing. Right. It's just preparing.

Jennifer Smith, CDE 49:15
Just prepare.

Scott Benner 49:17
So did we learn today that at the moment with the information that we have, that a person with type one diabetes in the Coronavirus is going to get some level of sick and they're going to manage their type on the way they would if they got any other virus and

Jennifer Smith, CDE 49:32
in a normal illness? Yes, exactly. And I would think, you know, unless you're really newly diagnosed, and you've been a fairly healthy person outside of the diabetes, and you've never really managed an illness with diabetes yet, then sure it will be very new for you, and it's going to be kind of scary, you know, but the biggest thing really is looking at the glucose levels looking where they're going and seeing Gosh, I'm you know, so 7500 points higher than I normally run. Clearly I need more insulin. So

Scott Benner 50:10
Jerry, what's your what's your level of commitment to the podcast? Are you willing to get the Coronavirus? So we can talk about what it's like to have it now.

Unknown Speaker 50:19
Can't get you to go look a couple of handrails or something like that.

Jennifer Smith, CDE 50:23
No, and I can go hang out at UW hospital. Sorry.

Scott Benner 50:28
Gosh, do you think health care workers who are in situations where they may be more susceptible? Do you think they should step back from their jobs? Like, what would you do if you are in a hospital right now working?

Jennifer Smith, CDE 50:43
So, you know, given my profession, I know that my position would have been not necessarily cut, but I would have probably been sent home because I would have been outpatient, I wouldn't have been necessary to be there. Right? If I were a nurse, or a doctor or any other profession that's absolutely needed. And you We need people I mean, what, what would happen with all the sick people, if all the doctors were like, all the nurses were like, nope, okay, I just gonna go hang out at home, I can't get sick. I can't do this, you know. I would have to say that I would, I would do my job. It's even if I had, you know, people at home as I do little kids, a husband, or if I had, you know, an elderly parent, or grandparent or something living, I guess I would just live at the hospital then. Yeah, I wouldn't come home with it.

Scott Benner 51:37
You know, yeah, we're in a situation now where everybody's got a row, the boat, whatever, where they have in their hand they need to use and it's very similar. You know, when you think about police officers, right, or emfs or firemen? What do they just gonna be like how your house gonna fire? I don't know if you have the Coronavirus or not. So we're just gonna have to burn your life. At some point, there are some a lot actually of professions that just you don't get to think about yourself first. Well, that's, you know, what ends up? Kind of,

Jennifer Smith, CDE 52:08
you're doing social good. By continuing to do what you professionally chose to do. It is. I mean,

Scott Benner 52:17
well, when I was speaking to Adam, the one thing I said that was interesting that I've kind of noticed from afar is that we have set up a society that, for the most part for most people, goes the way you want it to go. Do you know what I mean? Like there's not a lot of, like, I remember my parents, you know, talking about getting a car, and it taken them seven years to get money for a car. Do you mean like, we're gonna get a new car one day, they never got a new car, they would always get a newer car, right? But no one ever woke up and was like, I will just take out a loan, and then I will buy this car. And then I don't need the money today, I'll give it to them. Like, like, we've set up a situation where if you have any kind of income and need something, you probably can get it. And that goes for entertainment, as well. Right? Our entertainment are amazing now. Like, we're all at the point now where we're like Disney plus nothing on here. I want to watch it. Like we're a little spoiled. Right? Right. This is the first time in my generation, and definitely my children's where someone said that you're being limited and there's no alternative. Right? You just have to do this. Right? It's very interesting. And people are so far, I think doing a really good job with it. Yeah, I don't see people freaking out or anything like that.

Jennifer Smith, CDE 53:34
I think it's hard. Even from a from the from the child standpoint, though, you know, our kids have gotten so used to social interaction. Right? I mean, very minimal numbers of kids are homeschool. These days. I've got a couple of clients who have I work with Who are they do homeschool their children. And I've actually email I'm like, I bet you're glad that you've been doing the homeschooling you'll know exactly how to do this. I however, do not. So we've been after school or after I'm done with work in the afternoons. Now we've actually just been getting in the car, and going and taking a drive around the city. Just to like physically, like,

Unknown Speaker 54:16
get out, change,

Jennifer Smith, CDE 54:18
and change the visual and change and see that, you know, the world is still there. Everything is still in place. It's just that we've got limited interaction.

Scott Benner 54:28
It really is we're all just trying to stay away from each other so that we don't overwhelm the healthcare system. Right.

Jennifer Smith, CDE 54:34
And for explaining to kids it's also something for explaining to I mean, you know, with a seven and a three year old, they don't really quite understand, you know, why can't we go to the coffee shop and get a flowerless cookie? Why can't we you know, well, they're closed so we drive past the coffee shop. You have to kind of visually explain to many younger kids and well it's closed you know, we can't go and see all the chairs are up. But why Mommy, can't we get a morning muffin. Let's go home and let's make morning muffins. So now we have morning muffins sitting on the counter in the kitchen. Yesterday,

Scott Benner 55:06
I had that conversation with my 20 year old son. I was like, Listen, you can't play basketball. And here's why. Because Do you want to wonder for the rest of your life if your buddy's grandmother dropped dead because you had to go play basketball, you know, like, just go outside, you have a net play by yourself. And that's what this is gonna be for a little while. It's tough because you because it isn't. It isn't hard to look at what you're missing. Like, I watched kids on my son's baseball team and every baseball team who were seniors, who were eight, eight games into their season, be told That's it, you're never gonna play college baseball again, say goodbye to everybody and get back on the plane to go home. Wow, it was hard. It was really interesting. All these kids weren't going to graduate from high school at a ceremony maybe or from their college. You know, that's all total. But like I said, I think at one day, it will just be it'll just be a story to tell people. You know, like, remember the time I'll tell you this. And I mean, this, I said this to Kelly last night, I was like we are parenting through. Our parents never had anything like this, that I can remember that they had to be parents. And my wife's like, my parents just sent us outside anyway, we'd be dead. They'd be like, go outside and play, you know. So I really feel a feel like we're gonna be professional parents when this is over, like really good at it. Because this is just another level Jenny.

Jennifer Smith, CDE 56:22
It's really funny. I said that to Nathan, the other day, I said, this is really kind of a it's a social experiment in teaching people who've been so used to and nothing against it. This is the way that society work. Because moms and dads all have jobs now and you send your child to daycare or you send your child to school. It's teaching parents what it actually means to like spend majority of your time interacting with your child. I wonder if somebody else isn't raising your child? Yeah, somebody is else isn't teaching them. It's on you now. 100%? That's,

Unknown Speaker 57:00
that's hard. Yeah.

Scott Benner 57:01
Yeah, I listen, I've raised two kids, as a stay at home parent, right? That means you get up in the morning, and you're with them 24 hours a day. And it gets long after a while. And you really have to have the fortitude to just push through and find the good and what you're doing and not make it feel like oh my god, this is my whole life like that, that whole thing. But I'm wondering how many people will maybe I wonder how many people will try to go back to a single, like income, like how many people are gonna like this and think, Oh, this is nice, you know, right. I never thought it was possible.

Jennifer Smith, CDE 57:33
I didn't know my kid could do this. Or I didn't know I liked doing this type of thing with my child. Or look how good my child is that like reading and we can read together and we can learn all these things. I mean, I think of all the like, books that hopefully people are reading and the games that they're getting out of the closet that have cobwebs on them and like, Yeah, because especially with kids, you know, specifically, as you know, you have to entertain them up to a certain age, you kind of have to do the entertainment. Yeah, yeah.

Scott Benner 58:06
I've got my pile of books right here. I'm hoping. Yeah, really only five fingers crossed. So okay, so stay healthy. Keep your blood sugar stable. I think the other thing we didn't say that I think is really important is get sleep. And as

Jennifer Smith, CDE 58:19
bunk water.

Scott Benner 58:20
Yeah. And try not to make yourself nuts. Like stress, people don't sleep well. People don't sleep, well don't fight off colds. Well, like the really the things you can really do is, you know, take care of your health, get some sleep, keep your stress down. And you know,

Jennifer Smith, CDE 58:36
and some of that keeping your stress down ultimately is just keeping as much normal in your day as possible. Yeah, you know, you get up every day at seven o'clock, keep getting up at seven o'clock. If you always have tea at nine o'clock. Keep having your tea at nine o'clock. You know, it's just keeping some of those normal scheduled things, helps to keep the stress level down to I think, too, if you're working from home, I know everyone's interested, but don't leave like cable news on 24 hours a day in the background, because they're repeating the same thing over and over again. And it's getting into your brain. So right.

Scott Benner 59:07
Yeah, right, Jenny, I appreciate you doing this. And I hope you guys all stay healthy there. And I hope you do too. Thank you. I hope hopefully this will help some other people do the same. So I'm going to read to you from the CDC website for a second. Older adults and people who have severe underlying chronic medical conditions like heart or lung disease or diabetes seem to be at a higher risk for developing more serious complications from covid 19 illness, please consult with your health care provider about additional steps you may be able to take to protect yourself. The site goes on to remind us to stay home if you're sick. But I think at this point travel bans are starting to go into place as I'm recording this on March 20. So you know that may be that may just be a given at this point. Cover your coughs and your sneezes cover your mouth and nose with a tissue when you cough sneeze or use the inside of your elbow. Throw used tissues into the trash. Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available, clean your hands with sanitizer that contains at least a 60% alcohol. If you're sick, you should wear a face mask when you're around other people, even if you're sharing a room or a vehicle with them or before entering a health care providers office. If you are not able to wear a facemask or a sample because it causes trouble with breathing, then you should do your best to cover your coughs and sneezes and people who are caring for you should wear a face mask when they enter the room with you. If you're not sick, you do not need to wear a face mask unless you are caring for someone who is sick and they are not able to wear a face mask. face masks may be in short supply and should be safe for caregivers around the home clean and disinfect. This includes tables doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets and sinks. If surfaces are dirty, clean them use detergent or soap and water prior to disinfecting. The CDC goes on to tell you about disinfecting most common EPA registered household disinfectants will work. Use disinfectants appropriate for the surface. options can include diluting your household bleach. To make a bleach solution. Mix five tablespoons or a third of a cup of bleach per gallon of water, four teaspoons of bleach to a quart of water. Don't forget the manufacturer's instructions about proper ventilation when you're using bleach. And if you're going to use an alcohol solution to kill bacteria or the virus, ensure that it has at least a 70% alcohol content. This is all available@cdc.gov there's guidance from the CDC around the 15 days to slow the spread. Listen to and follow all directions for your state and local authorities. If you feel sick, stay home Do not go to work, contact your medical provider. If your children are sick, keep them at home Do not send them to school well. Think that cats out of the bag to around most of the country contact your medical provider if someone in your household has tested positive for the coronavirus. Keep the entire household at home Do not go to work, do not go to school, contact your medical provider if you're an older person stay home and away from other people. And if you are a person with a serious underlying health condition that can put you at an increased risk, for example, a condition that impairs your lung or heart function or weakens your immune system stay home and away from other people. Okay, so here are my plans for the podcast. Next week. There'll be two episodes that are just stories from people with type one diabetes stuff that's more entertaining. We're going to do some after dark stuff, you know stuff to keep your mind off things keep you entertained. I will come back with Coronavirus information whenever it's necessary. Dr. Needleman we'll come back on Jenny and I'll talk again. But the podcast is going to be here for you. I'm trying to figure out how to do a live chat for us all. So if people just need to feel a little less alone, they can get together and talk. that'll probably happen through the Facebook page. So keep an eye there. Perhaps even Instagram and I'm looking for a way to bring everybody in. Maybe in a third party platform. I'm doing my best on that. The Juicebox Podcast will run as scheduled. It's not going to go away. And I appreciate that you guys are such supportive listeners. I hope this information has been valuable for you. Please just use your common sense. Stay well stay away from people. Don't touch things. Wash your hands. be cognizant of your surroundings. Do your best to stay safe. Do your best to stay healthy. If you feel sick in any way, please contact your physician immediately. I'm going to read you one last thing the symptoms of coronavirus. People may be sick with the virus for one to 14 days before developing symptoms. The most common symptoms of coronavirus disease, the COVID-19 virus are fever, tiredness and a dry cough. Most people about 80% recover from the disease without needing special treatment. More rarely, the disease can be serious and even fatal. Older people and people with other medical conditions such as asthma, diabetes, or heart disease may be more vulnerable to becoming severely ill. People may experience cough, fever, tiredness, difficulty breathing in severe cases. Now having that in your head. Don't forget what Jenny and I talked about today. If you're a healthy person, if your blood sugars are well maintained, you don't fall into that category just because you have type one diabetes. Be healthy, keep your routine going. Keep your mind fresh, get some fresh air. Try not to go crazy in your house a little bit. You're going to be okay. The Juicebox Podcast is sponsored by Omnipod Dexcom touched by type one and the Contour Next One blood glucose meter. You can go to Contour Next one.com touched by type one.org My Omni pod.com forward slash juice box or dexcom.com forward slash juice box to learn more about the sponsors. There are links in your show notes at Juicebox podcast.com. If you can't remember those links, now might be the perfect time to check into some new gear, the stuff you've been thinking about getting, I mean, you got a lot of time to read up, right? I genuinely meant what I said to Jenny earlier, I'm not just trying to get you to listen to the podcast more. If you want to work on your variability if you want to work on keeping your blood sugar's more stable. Go back to Episode 210 of the podcast and listen to the diabetes pro tips again, you can figure it out if you're struggling. And if you knew what you were doing in the past, but you've sort of burned out a little bit. This podcast episodes can help bring you back around again. I want to wish you all a ton of success. I'm gonna see you soon. You guys are going to be okay. I'm gonna be okay. We're all going to be okay.


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#314 Adam Naddelman, M.D. discusses Coronavirus

Scott Benner

Coronavirus COVID-19 discussion for 3-16-2020

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon AlexaGoogle Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Adam Naddelman, MD 0:00
My name's Adam Naddelman. I'm a pediatrician at Princeton Nassau pediatrics in Central New Jersey.

Scott Benner 0:10
Hello, everyone. Welcome to Episode 314 of the Juicebox Podcast. Today, we're going to talk about the Coronavirus situation. This one's going to be an overview with one of the brightest, most thoughtful doctors that I know personally. Adam and I met. A long time ago when Arden was born. Dr. Adam Needleman joined the Princeton Nassau pediatrics group in 2001. He completed his pediatric residency from New York hospital, Cornell Medical Center, and was chief pediatric resident the following year. Dr. Edelman received his medical degree from the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson medical school in New Brunswick, New Jersey. He attended the University of Pennsylvania in Philadelphia, where he received a BA in biological basis of behavior. Dr. Edelman is board certified in pediatrics, and is a fellow of the American Academy of Pediatrics. So please don't judge him. You know, because he knows me. He's a pretty smart guy. Despite his tastes and friends. I'm going to ask you to please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. Today's episode of the podcast is sponsored by the Omni pod tubeless insulin pump, you can go to my Omni pod.com forward slash juice box or click on the links right here in the show notes of your podcast player to get an absolutely free no obligation demonstration pod sent directly to your house. Omni pod will send you a non functioning pump but otherwise it does everything else meaning it looks the same. It's the same weight you can wear it and find out if you like it in my experience wearing a demo pod. You forget that the only pods even there after a very short time then it's kind of up to your imagination what's it going to be like to live with it to shower with the to work out with it? Normally I would say go to school or something but you know right now maybe you'll just in your house what it would be like to wear the Omni pod anyway, to get an absolutely free no obligation pod experience kit. Like I said my on the pod.com forward slash juicebox. Not even the Coronavirus should stop you from making plans to take better care of your type one diabetes. Please don't tell me I was thinking of getting a pump. But oh, this whole thing happened. Don't do that. Just keep moving forward with your health. podcast is also sponsored by the dexcom g six continuous glucose monitor. That is the CGM that my daughter has been wearing for ever and ever. It's the continuous glucose monitor that we use to make decisions about ardens. dosing. Right? When does she eat the stop below? When does she give herself insulin to stop a Hi, how do we Pre-Bolus for meals? What are the trends look like? How do we set her basal rates overnight during the day while she's in school while she's at rest when she's sick when she's well. The data that comes back from the dexcom g six tells you everything that you need to know to make great decisions. And then you can make those decisions with your needles with your pens with your Omni pod, however you get your insulin dexcom.com forward slash juice box. Find out about it right now. Okay, so my Omni pod.com forward slash juice box dexcom.com forward slash juice box. And when you're all done, and this whole Corona thing is overwhelming you you need a happy place to go touch by type one.org. Go watch some little kids with Type One Diabetes living well for a little while, check out what they're doing. Find out how you maybe can even get involved. That'll be good for your soul, touched by type one.org. And now, my friend, Adam Needleman. My goal here is for people to have a really firm understanding of what's going on because I feel like the media, you know is actually I'm seeing them try really hard to do a good job. But it's all piecemeal, right? you'll flip it on, you'll hear one thing, you can't listen all day, you can't listen every time they update their thoughts. And people have been listening for two weeks now. And two weeks ago, it was, hey, there's this thing happening somewhere else in the world. And maybe it won't happen here. And I just think that everybody's got fragments of an idea. So I guess I want to start like simply by saying it's a virus, right. But Corona isn't just this thing that we're dealing with right now. Am I wrong about that?

Adam Naddelman, MD 4:43
No, that's correct. So coronavirus is just the name for the family of viruses. Like for instance, I'm sure most people have heard of SARS from a few years ago and there's another one called MERS that was a basically in the Middle East. Those are both in the same family of viruses. They're different strains of this Same virus

Scott Benner 5:00
family. Okay. And and so do viruses just appear? Do they mutate from other viruses? How do they happen?

Adam Naddelman, MD 5:10
Well, so they typically will mutate. So the thought here is that this most likely originated in an animal, the thought is perhaps probably a bat, in bohan, where they have these open air markets, where there's a, yeah, there's a lot of food, a lot of animals really, that are alive and in these markets. And the thought is that perhaps the virus was sort of native to an animal. And again, the thought is a bat. And then it mutated in some way that allowed it to jump from an animal to a person. It's similar to what happens with like, avian bird flu, where you see this in Asia every once in a while where there's a some strain of a bird flu that gets into chickens. And people get really panicked that it's going to mutate and jump to humans. So they start literally just killing off like hundreds and hundreds of chickens, in order to prevent that from happening. So this happened, it may it may have happened and jumped to multiple people at once. Nobody really knows. But the cluster clearly is the cluster of cases, that seems really seems like it started this all came from that area of China, right. And what

Scott Benner 6:16
I've been able to kind of glean about these wet markets is that they bring the animals in, and they keep them alive for freshness reasons, and then they start they slaughter them as you buy them and cook them right there. Except you have a situation where one kind of animals in a cage stacked on another kind of an animal, they would never be that close to each other in nature and,

Adam Naddelman, MD 6:36
and they wouldn't be that close to someone who was actually like preparing them for sale and for food. And they it kind of reminds me of like the old time butcher shops where you had like the animals hanging sort of in the window, but they were never alive, like you didn't go, you know, you'd go into the back and pick out your lamb or something they were hanging in the window. This is similar to that, except that the animals are alive. And they're stored, like you said, kind of in close quarters. And I don't know exactly how whether or not the those markets would meet the same kind of hygiene and sanitary requirements that we have in the US, etc. So you just don't know. But that's where the thought is that it came from.

Scott Benner 7:12
Yeah, some some of the images I've seen online, these things are being cooked on just wire grates or trash can lids and being slaughtered at the same place, they're being cooked in the same place they're being eaten. It really is. I mean, not that I know a lot about it, but it's it's overpopulation people need to eat, you know, and when there's not when there's not farm produced food, they have to go out in the, in the wilderness, and in this case, find bats and whatever else they can find to stay alive, you know.

Adam Naddelman, MD 7:38
So yeah, but the thought is that it probably jumped. So the virus must have mutated from whatever form it was in before and then jumped to a person and it was highly infectious at that point, and very efficient. So it would, it was very easy to pass from person to person, which is why it's spreading as quickly as it is. And then on top of that it unfortunately has the added characteristic of being quite a bit more dangerous than like a typical flu or a cold virus would be.

Scott Benner 8:07
So let's talk about how it transmits. It's, when they first started talking about it, it was I heard a lot of like, wash your hands, you know, but now I'm hearing more than it's airborne, or be on surfaces,

Adam Naddelman, MD 8:19
there are very few viruses that are actually airborne. measles is probably the best example of one. measles is probably the most infectious agent that we've ever encountered. Like if you take a person with measles, and you stick them in a room with 100 people that have either not had it or not been vaccinated, and you just let them kind of hang out in that room for a while 90 people in the room will get it, then so that's airborne. And that's like incredibly infectious. This is not that at least as best we can tell this looks like it's actually through droplets, which that just means you sneeze, then the virus is expelled from your mouth, your mouth and your nose. And it's on a little droplet of you know, fluid. And that either lands on a person or lands on your hand. And then I shake hands with someone and then they touch their face, and it gets passed that way. So the problem though, is with droplets, it can look like it's behaving like it's airborne, because if you sneeze on a surface, it can survive on the surface for sometimes as long as you know, several hours, then if someone else comes along and touches the surface touches their face or mouth, they can pass it to themselves that way.

Scott Benner 9:23
Is that uncommon for viruses to be able to survive like that on the surface of something

Adam Naddelman, MD 9:28
in a dry? No. I mean, the ones that are through droplets can survive. It's just this one seems to be a little bit more kind of Hardy and how long it can survive. It just it seems like it's it survived for a while. What they're saying now about this virus in particular is you really need like, this is what the guidance says it has to be more than 10 minutes of kind of face to face contact with a person that's less than six feet away. So you can see where all this social distancing stuff and I know I'm kind of getting ahead of myself a little bit but that's where a lot of this these thoughts Coming from,

Scott Benner 10:00
right. So if we just don't have those interactions, we won't pass it around. And, and I guess one of the bigger issues must be that the incubation period takes a while, right. So once I'm affected by it, I might not show symptoms for a while or at all.

Adam Naddelman, MD 10:18
Yeah, so you can be infected and be completely asymptomatic. And some of the data that's coming out from what we're seeing overseas is, looks like people who are asymptomatic are sometimes the highest shadows of the virus, which is why it's so crucial to do the 14 day thing, because the thought is, you probably can be asymptomatic for as many as four or five days before you start either showing symptoms or your body just lights it off. But once you start showing symptoms, the guidance now is that you really ought to be symptom free for a week before you put yourself around other people again, so you could see where the 14 days certified before seven after that kind of a thing. And now it's not precise. And if you're sick with the virus, and it's confirmed, it's probably a little bit different in terms of timeframe, because it depends on how sick you get, how long it takes you to recover. But that's kinda where that comes from.

Scott Benner 11:13
All right, that makes sense. So there's just, there's no end to be really when you stop and think about regular life. You don't realize when any of these situations are happening, honestly, like if somebody sneezes like, it's just you're like, oh, God bless you. You don't think right? Now I have this because even if we get sick, it's interesting, isn't it? Like we don't live, at least I don't live thinking, Oh, I'm gonna get sick. And if I do get sick, I just think, Oh, no, I got sick, and then I'll wait it out or lay down if I depending on how bad it gets. But I never think I'm sick. And this can be passed on to so many multiples of people without me knowing it's happening.

Adam Naddelman, MD 11:52
Now, it's a great point. And one of the things with this virus, too, that makes it a little bit unique, I guess are not unique, but it just makes it more dangerous is it's a little bit more infectious. We think then what the flu even is. So they talk about viruses. And they use this our number, which is basically just a, a variable that gets factored into how they do a lot of these calculations in terms of how infectious thing is, but it basically how many people are you likely to infect if you yourself get sick with that illness. So like I said, before, with measles, if you're in an unvaccinated population, you're going to infect a whole ton of people, just a ton of people, right? with the flu, the average flu and an average season, you're probably you're like, say somewhere between one and two and a half people on average. With this, this appears to be more like two to three and a half or four. Now that doesn't sound like a big difference. But imagine a class of like 30 kids. And if you're gonna if every person and there's likely to infect three other kids, the whole class is going to be sick unless you split them all apart, right? If you only get infected one other person, then you're probably it's probably not going to get to everybody before there's some level of protection within that classroom because you have kids that are now immune.

Scott Benner 13:11
So I've seen a lot of those people are making visual representations of what you're just talking about where, you know, there's like 1000 dots bouncing around in the box, and they give, you know, three of the dots the Coronavirus, and as they start banging into each other, it moves across. And it is fascinating to watch how quickly that happens, how quickly three can turn into six that can turn into 12. And it just multiplies so amazingly fast in random ways that you would just just couldn't imagine, I guess.

Adam Naddelman, MD 13:40
Yeah, I mean, that's exactly what we're talking about. I saw another good one the other day, which was like just a matchbook with four matches close to each other, and one that was further away, and you just like the first one, and then they're all gonna light. And then the fifth one that's further away, it doesn't like the same idea. But the one that I saw the same simulation you're talking about, I think was from the Washington Post. And that, to me was the best example. It was just sort of the random movement of people in a grocery store. And if, if, you know, that's really if it was airborne, like if you all if all you needed to do was sort of walk past someone and you could get it, then yeah, that really makes sense. But it's the same concept. And the more infectious it is, the more likely you're going to be in a scenario like that. I just

Scott Benner 14:19
think it's important to remember that most of the actions that are going to cause this the transfer from person to person are not things that you're aware of, you can't you know, you can you can say don't touch your face, for instance, but, you know,

Adam Naddelman, MD 14:31
it's impossible

Scott Benner 14:32
doubt yourself from doing that. Right, just the same as you when you approach somebody, it's really common to feel like you want to reach out and shake their hand or if you're closer to them, you want to give them a hug and you don't you don't imagine like, hey, that guy sneezed five minutes ago, and then I'm gonna hug him. Then his collar is going to hit my collar then later I'm going to adjust my collar and then later I'm going to pick my nose and then I've got the Coronavirus, right.

Adam Naddelman, MD 14:54
Exactly. Nobody thinks like that. And that's why I think it This has been such a challenge for so many people. Just the process. I mean, I think, you know, it's easy to say, Oh, you know, these people should all understand why they need to do this distancing. But it just doesn't. We're not, we've never been in a situation like this before, where you have to have such a high level of awareness of your personal space, and who you're letting into that space and whether or not you let your kids do certain things. It's just not normal for us to have to deal with it. And it sort of runs counter to everything that we do, like you're saying, on a regular basis. I mean, you're supposed to greet people, you're supposed to hug people that you care about, you're supposed to go visit your relatives, you're supposed to have, you know, fun with your friends at a restaurant or a bar or something like, it's to think that you have to sit in your house and spread yourself out and not get near anyone, it's just, it's really hard to fathom that we could be in this situation, but there is no doubt that we actually really are in this situation.

Scott Benner 15:48
This is not someone's imagination, this isn't media hype, it's

Adam Naddelman, MD 15:51
now is happening, I think you can make a really strong argument that we were actually pretty slow on the uptake of all of this with the knowledge that we had about what was going on to the rest of the world. And that's, I think the fear that a lot of people have, it's just that it may be too late. Like, there's a lot of people that believe once you get to, say 1% of the population, or, you know, maybe 2% of the population, once you get to numbers like that in terms of people infected, you can't contain it the way that we are trying to it. That's why now they're clamping down so hard so quickly. Because I think finally it's really sunk in. And I think the governors are the ones really leading the way on this, because they're the ones that have the costumes right in their backyards. But that's really where that all comes from. I was talking to Kelly, and she said, if this persists into a second season, I don't see how most of the population won't have had this in one way or another a year from now. Yeah, well, it's a lot like the Spanish flu, or the h1 and one from 1918. That's exactly the model of what we're talking about here. And that's exactly what happened. So you had this time of year, incredible outbreak where no one had any level of protection, there was no flu vaccine back then, like we have now. And there were no antivirals. And the conditions were not what they are now. And so a lot of people got sick, and then it kind of started to Peter out a little bit. And then when the fall came, it came roaring back. And now this is probably a little bit different than that. That particular strain of flu was just for whatever reason seemed to really kind of persist for longer than you might expect. But yeah, I mean, this virus, nobody has any native protection to it. And so we're in a similar situation where you could end up with a second wave, like we're talking about later in the fall.

Scott Benner 17:40
I think for people who can't believe that it could reach everybody, at some point, think of this, if you can, it's it's apples and oranges. But it's apples and apples in the same way, I think and you'll stop me if I'm wrong. We all have the common cold at some point during the year, nobody goes through a calendar year and doesn't have a cold, right? Like it happens eventually, which means these things get passed around in ways you don't imagine is that is that a similar way of thinking of transmission? Well, it would be if you weren't doing all the things that are happening out. So the whole goal of all this social distancing, and the you know, getting rid of all the

Adam Naddelman, MD 18:18
sports and Broadway and restaurants and all that is, the thought is that if you can get that coefficient of infection, that R value down to like under one. So if you get it, you're likely to only give it to just one other person instead of two, or three or four, that changes the whole thing. Because then you can get, like, let's say it gets into my house, just God forbid, but let's say that, and I get sick, and I give it to one of the other, you know, four people in my house, then and then the two of us both get better. After the 14 days we self quarantine, we're better in 14 days. And between the two of us we only I only give it to one person. So you can make an argument that the are like in my house was point five, right? Okay, you can see how then it died out, you know, and like my little cluster of it just stopped. I didn't go that I didn't go and give it to 10 other people, it just stopped. picture that all across the country. So if there's, you know, I don't have any cases are reported. Now it changes by the minute, but say there were 10,000 cases. If everyone did that, and only gave it to half of another person, then all of a sudden the new cases being reported that number will start to drop. And you'll get to a point where it doesn't have a way to get around enough in the community. But that's exactly why if you're going to make this these kinds of measures work, they have to be across the board across the country, you have to lock down travel you have to do all of that. Otherwise, like you're saying it what's to stop it from you know, okay, we do that we do a great job for three weeks and then a whole bunch of people come over from wherever they're from. They're where they all have it on a cruise ship and they get off they get off the cruise boat, you know, cruise ship in Miami, and boom, it just started here it starts up again. So everyone has to do it at once

Scott Benner 19:56
right so there's a way to affect there's a there's going to be a curve either up or down. And we can impact it by doing all the things that people are talking about, we're gonna talk about those things, too, so that people understand, I just think it's really important for people to hear, there's no way to just ignore this and stop it. You know, you're not gonna do that.

Adam Naddelman, MD 20:16
I mean, what I was saying earlier today, when I was talking to somebody else, just, I think you have to think of this as not so much that you don't want to get sick, it's that you don't want picture the person in your life who is the most well, most vulnerable, you know, whether that's a grandparent, or it's a relative that's fighting cancer, or it's a, you know, newborn baby that has medical issues, what whoever it is, and picture like these actions being put in place to protect that person from getting it. That's really I think, the way you have to think about it, because those are the most vulnerable people. And that's who we don't want to see all piling into emergency rooms, all at the same time.

Scott Benner 20:54
Yeah. And you have the diligence that's involved is, is extraordinary, actually, because if you think about when you're sick at home, maybe I'm just speaking for myself and about the gross people out. But you know, you make this you live in a family, you make an announcement, at some point, Hey, no one touched my drink, I don't feel well, you know, you mean or you've got kids and there'll be like, Hey, Dad, give me a drink your water that happens all the time. But you know, after a couple of days, once you're not not in anymore, you don't think to say to anybody, your kid comes by and grabs a water or you hug people or give them a kiss again, this is where I think it's going to be difficult for people not just to remember not to do it, but to be militant about the time that it takes, right, you know, now say I do that, say in your scenario, you come home, you have it, you end up only giving it to one other person your house, you wait the 14 days, you're both good. If the third person your house, gets it and brings it back in, can you get it again?

Adam Naddelman, MD 21:46
So that's a great question. It looks like I mean, again, it's just so hard because there's not enough testing to really prove all of this. But when you look at the what people are experiencing overseas, because they're ahead of us, they are not seeing reinfection at all. They're just not now, is it possible that the virus at some point mutates and there's a second strain of it, and maybe you can get the second strain? I guess it's possible. But that's not what's being reported at all at this point. Which is actually very promising, because when a vaccine does get developed, it can be against this particular strain of coronavirus. And you would hope that it would be effective. For that reason? Is there a chance that it could just morph again? Yeah, no, there's, it can mutate and change. I mean, there are lots of I that's what happens with the flu virus every year now that this is a different kind of virus. But the whole reason why you have to get a flu shot every year is that the strains will shift and change over time and turn into slightly different strains than they were the year before. And if you have just last year's flu shot, it's not going to be as effective as the one for the current season. Now, this is not the same type of virus, so it doesn't behave exactly the same way. But that's, in general, that's just a kind of a, like a

Scott Benner 22:58
kind of nonspecific or broad way to think about it. Is that in I realized this is a layman's term, example. But is that the virus or the flu in that other scenario? Is that that thing just trying to stay alive? Like, is it does it adapt? Like, is it adapting the way I think of, you know, we don't need our appendix anymore. Like,

Adam Naddelman, MD 23:19
sort of so think of it this way. It's not so much. Yeah, that I mean, that is the way to think about it. But it's, I think you have to just think about it as more like a series of random events, right? So you have these, this flow that's out there, it's probably mutating slightly over time, and the antigens that kind of get presented on the flu virus that ended up being what triggers the antibody reaction, and you, those are shifting slightly over time. And there's some, at some point, like one of them hits the jackpot and says, okay, we shifted, now we can infect people more easily now we can evade the antibodies that this person has from the flu shot they got last year. So now I can get past person a person. It's really just evolution, it's just shifting, there's little mutations that caused it to shift slightly, that at some point conferred advantage. And that advantage allows it to be passed person to person more easily or allows you to, you know, evade Tamiflu or allows the abaza to evade the the antibodies that are in your body that are from your Western flu shot like that's sets the way it works, typically. So thinking out into the future, it's completely possible that this will run through society will build up some sort of an immunity to it, it will dissipate. And as long as somebody doesn't decide to eat monkey brains next year, we should

Unknown Speaker 24:38
be like, like, don't I mean, like, is

Adam Naddelman, MD 24:39
this? No, I mean, yes, yes or no? Say it that way. I just wanted.

Scott Benner 24:45
This is our new normal, like, Have we reached a new level, like five years from now? Is there just going to be Corona season?

Adam Naddelman, MD 24:50
No, not necessarily. I mean, I think that this is probably going to look more like what happened with SARS and MERS. The difference with the with SARS especially Which is a coronavirus that was in Asia, but never really got out of Asia. And the only reason was for some reason that back that virus, when it jumped person to person, it tend to weaken a bit. So I know I'm not I'm not sure anyone really understands why this is. But by the fourth or fifth jump, it kind of petered out, it became much less infectious. So it was hard for it to get out of where it was, it infected a lot of people in those areas, a lot of people got really sick, but it never like, made the leap onto a cruise ship and ended up in the United States or ended up on an airplane. And, you know, there might have been isolated cases here and there, but it wasn't infectious enough. But ya know, it's look, I think that we're in a very connected world, it is very easy for an infectious agent like this, to jump and end up in the US or to start in the US and end up somewhere else. I mean, with the way people travel now, it's virtually impossible to expect that this wouldn't happen again, at some point down the road.

Scott Benner 25:55
Well, so then. So then I guess the question is, I think what people's there, I think fear, obviously is alive around the subject. I think most of its around the disruption of life, even more than health, at least the people I've talked to so far, I think we've done such a good job in America, at least in building a world a life for people where they get to do mainly what it is they want to do. Like, we're not used to being told no. Right? Yeah. You know, like that, that sort of thing doesn't isn't a custom. I think people don't want to get sick. But I actually think that it really, it really is more towards the people who are at risk. I think the people who feel like they're not at risk are probably like, whatever. So if I get sick, I get sick.

Adam Naddelman, MD 26:38
Well, and I think that explains why you saw so many people who thought it was a good idea to go to restaurants and go to bars and basically forced these governors to say, all right, you know what, you guys, that's it, you're done. Like, it's almost like when your kid won't get off his phone, and you have to eventually take it away from them. I mean, I think you're right, people are not used to this. And they don't believe it's a bad combination, because they're not used to it. And there's also a pretty significant level of mistrust. Among the way the population looks at authority figures and expertise and the media and the politicians and everybody else. Everyone's like, yeah, whatever, it's fine here. But this thing's all the time, no big deal. And people don't don't take it seriously. I mean, they're pictures of people at Disney World. Yesterday, it looked like any other day at Disney World, or, you know, people in restaurants or there was a data clear out Bourbon Street a couple nights ago, because people were out partying till all hours of the night, not taking it seriously. And you know, it's not their fault. I mean, this is like you said, this is the society we're in and, but you need really strong, really clear and kind of consistent messaging.

Scott Benner 27:43
explain to people why this is so important. That's why I wanted to do that's why I appreciate you doing this so much, actually, because I just I don't know, I, you look around you think this this is your reaction to this, like you know, it that Oh, I'm not in the in the group that's at risk. And by the way, too, for people listening. Watch how you say something like that out loud. Oh, it's only killing old people and sick people? Well, you know what, that's a hurtful statement to older people. And you know, people who have pre existing conditions, especially for most of the people listening this podcast, and I want to talk about that too, and find out if people with type one diabetes are at a greater risk. But I want to first find out how you're treating people. So you're a pediatrician, and are you getting massive amounts of calls from everybody now? I guess we'll go back for a second. I was with my son a few days ago, he was playing baseball, and he got sick. It started with a runny nose. And then he got kind of wiped out his throat started to hurt. He had a little bit of an intermittent cough. Looking back on it. He was in a warm weather place and he's got allergies. So the nose and the cough were probably the allergies and the sore throat ended up being most likely strep. But in that moment when it all started happening, and we were like, intermittent cough, it's not wet, his throat sore, you're like, Okay, he's got Corona. You know, like, your brain just jumps right to it. Now luckily for me, I was able to text you, but I texted you from right from urgent care because I took him right out of a situation took him right to urgent care. And I thought, Let's find out. You know, what's up with this kid. But the first thing I find out when I get there, so big sign hanging up, says, Hey, if you think you're the coronavirus, we don't have any test for that. So you know, put this mask on and wait your turn. So it turned out that gave him antibiotics. And he's of course significantly better now because he had it he had strep throat. But I'm trying to imagine all of the people in all the towns across the country calling their doctors offices that that is that your exists

Adam Naddelman, MD 29:47
right now. We're pretty much

definitely you know, my friends like you who text me and said

no, but it also is just No, it's okay. In all seriousness, yeah, I mean, everyone is concerned I mean, I'm sure, you know, for all the people that are hearing this, I'm sure there you have friends that are saying, Oh my god, I'm congested. I wonder if I have it. Or I'm coughing, I wonder if I have it, you know, and it's difficult because the numbers that we're seeing from China and from Italy, as best we can tell, at least 80% of people that get it are going to have a mild illness. Probably even more than that, it's probably a higher number than that, because we can't actually test everyone who's walking around with the symptoms like you described, but at least 80%. You know, it could be as high as 90%. But at least 80% of the people are going to have a mild illness. So what we're doing because we can't test, as you said, at least not yet, there are very strict criteria for who can actually be tested. But what we're doing is just saying, Listen, thankfully, and children, for whatever reason that it appears that the virus is actually quite mild, in general. So we feel very comfortable saying to the vast majority of our patients, if you're congested, if you're coughing a little bit, if you have a little low grade fever, you're okay to just hang tight at home, stay away from other people as best you can. And let's see what develops in the next couple days, and the vast majority of those kids are going to define as if they had a cold. Now, would it be great to be able to do a swab like we do for strep to say, hey, look, you have it, and then to prove to people that you had it, and you were fine, of course, but that doesn't exist right now. When you say in children, is there an age range you're seeing, they're saying that from all the numbers I've seen, it's really, it's really lm under 18. There are a few reported cases in overseas of, of older teenagers that got a little bit sicker than you might expect. But again, without knowing the background on them, it's hard to really say, but everything that we've seen so far is that kids under 18 are really my whole, almost our entire population other than the college age kids are, are really gonna have a mild illness. And it does look like you're the risk factors in terms of being hospitalized or ending up in an ICU. It really ages a huge part of it. So we've interpreted that to mean that if you're young and healthy, which most of our population is, those children are going to be fine. Now, you asked before about type one, there's no data yet that shows that type one is a significant risk factor for especially for the pediatric population. For severe illness with this, I would assume like any other infection, very poorly controlled type one is going to put you at a higher risk for for just getting sick in general. And the virus itself is likely to assuming Yeah, and it will also like in the way that all of you that are listening to this know that when your kids get sick, their sugars are all over the place, it's harder to manage their insulin, that is likely to happen with this too, but not to any extent any not at any greater extent than any other illness that they might get.

Scott Benner 33:01
Okay. It's It's funny, I was making a note to ask you a question, you kind of lead into it. The one thing that occurs to me while we're hearing numbers, you know, five guys found it, you know, had here and another thousand people here and you start hearing this thing? Is it? Is it your health? We don't ever think about that you don't ever get to see the person, you know, is it a person who's in poor health in other ways? Is it perfectly healthy people like it? Does it skew more one way or the other? Have you seen any data data about that yet?

Adam Naddelman, MD 33:30
Well, so there's no doubt that pre existing medical conditions are more likely to lead to more severe illness, like if you look at the population of people that ended up in the ICU in China or in Italy, like the average age of death from this in Italy is 81. Now Italy is a very as a much older population than we have in the United States. And their health care system is a little different. And there's all kinds of rules and regulations that are there. But so that's one, you know, one piece of information that I think is important that 81 for Italy. When you look at the numbers in Wuhan, China, it looks like being older than 50. And definitely being older than 60 or 70 are risk factors. Now 50 is probably I don't know how significant it is. 60 is starting to get significant. 70 definitely significant. So age is a factor. They found that men who were hypertensive with uncontrolled blood pressure that clearly was a factor. And now in that cohort, but again, without being able to do widespread testing, you really don't know these are all the sickest people they're looking at. They're not looking at every person who's sniffles and turns out the habit like some of these famous people that you're seeing in the media, right? Tom Hanks has it. Idris Elba has it now the player on the jazz that has it. Those guys got tested. Like they were sick for like five minutes and got tested and prove that they had. As far as I know, they're all doing just fine. Now if we could test every person that had that level of symptoms, it would probably be a little bit more reassuring because we could say it's About 80% that are mild, it's a higher number than that. The only thing that I think has us worried is, in some of the countries where you're getting a lot of testing now, like in China, the the rate of serious illness and the rate of like ICU admission, and even death, they haven't decreased as much as you would hope, the only place we're seeing the numbers come down in South Korea, and that they are doing an unbelievable amount of testing. And so the mortality rate there, it looks like it's significantly lower than it is in places like China, or in Milan, in Italy.

Scott Benner 35:32
I think that it's interesting, too, that you're seeing some, you know, the really well controlled places are seem to be smaller countries, that is countries that aren't as landlocked sometimes, you know, like they're having, it's just like you were talking about earlier there, it's easier to restrict people from coming in and out, which should say to you, if you're listening, it should say to you, I need to restrict people coming in out of my life, just like you need to restrict them coming in and out of your country. It's it's all the same thing. You're, you're just trying to limit contact with people,

Adam Naddelman, MD 36:03
right? To keep this from happening. And so yeah, you could see why like, going to an NBA game, going to march madness, yeah, going to a concert, or a Broadway show. All those things are tremendous, tremendously dangerous in a situation like this. So it makes sense to not be doing them now. It made me wonder

Scott Benner 36:22
from the conversation so far, if as we get further away from where this began, if you will see it impact less people at younger ages, like will it get? Will it weaken? Or will this be a virus that doesn't weaken as its past? And I guess there's no way to know that now. Really?

Adam Naddelman, MD 36:43
Yeah. So so far, it's not showing the same signs of weakening the way that SARS did like I was talking about earlier. But the hope is, like, if you look at what's going on, in Wu Han China, now, they clamp down an unbelievably crazy amount compared to what we could ever do here. And because they did that, they essentially got all of the active cases, away from everybody else, quarantine them, force them, essentially, to not even be with the people that they wanted to be around that all like they pulled him out of their houses in some cases. But by doing that the person each person fought off the virus, and then they're not contagious anymore. And so they can go back to society. And if you look on the news, now, you'll see videos of people walking around, whoo ha, and like, you know, I mean, not like nothing ever happened. But they're getting back to normal, because they took they took what we're doing here, and they turned it up about 10 more notches, and

Scott Benner 37:36
they were able to because I guess freedoms, not such a concern there.

Adam Naddelman, MD 37:40
Yes, there is a bit of a trade off, which I wouldn't I mean, there's videos of them, like spraying down the streets and crazy stuff. And pulling people out of houses like that, that will never happen in the US. But that just means it's going to take us probably a little longer than it took them.

Scott Benner 37:53
I saw something online that really made me smile The other day, some it said, your grandparents were asked to fight a World War, you're being asked to sit on your sofa.

Adam Naddelman, MD 38:00
Yeah, I mean, in all seriousness, like you, I mean, we all have like 40 hours of TV we'd like to watch and probably, you know, at least 50 hours of podcasts and books to read and all kinds of stuff. Just go and enjoy that stuff. Just go sit down and relax. My son

Scott Benner 38:14
said the most thoughtful thing about it so far. So you just said to me He's like, this is just like summer vacation. I don't really need to do anything. And I was like, yeah, hundred percent. Just go relax. I said, just take a vacation. We're just gonna take it here in the house. Yeah. Now when I when I find myself in the grocery store, are there ways to protect myself? Like when I do have to go out? What do I do?

Adam Naddelman, MD 38:35
Yeah. So I think ideally, you go at a time when perhaps it'll be less crowded. A lot of the grocery stores are doing some clever things like only every other register is open. They're putting a shopping cart between customers. So you can't get within six feet of the person in front of you or behind you. You're not going to stand in line with some guy on the line next to you and watching sneezing and coughing or whatever. So you're going to be spread out. I think you want to get in and out. It's not the time to like, you know, debate which peaches you want to buy for 10 minutes. Like, grab what you need to get out.

Scott Benner 39:08
I am we were so Kelly and I went together. And it was hard. First of all, it was very interesting for anybody that's been out. It was quiet, solemn, almost like there wasn't a lot of extra talking people were very, I think they were trying to be calm, but felt like on edge. Everybody looked at each other a little weird, you know, like when you are passing by. And I watched Kelly pick up a jar of pickles, and put them down and decided against them. And then she changed her mind and pick them up again. And I was like, well, you stop handling everything. Even though if that made sense or not. But I was like, decide if you're gonna buy the pickles by looking at them. And then that made me think about that, like you start your brain starts going. So somewhere there's a woman who's a nurse and she came home at the end of a night shift and she's got the virus on her. She kissed her husband, her husband came to this grocery Or put these pickles on the shelf? My wife touched him. Now we got it. Right. And it's hard not to do that calculus in your head while you're while you're looking at things and doing

Adam Naddelman, MD 40:08
Yeah, this is this is a difficult time for people that have any level of anxiety. And in all seriousness, I mean, you really can make yourself insane. By running those scenarios in your head about every single thing. I mean, the good, the good thing is, like I said before, over 80% of people are going to get a mild illness. So even if you were unlucky enough to pick up the pickle jar that was handled by the nurse who kissed your husband, or whatever you said before, you're likely going to be okay. I mean, even though we worry a lot about the rates being higher than what you'll see for like a typical flu season. I mean, we're not talking about like some movie, you know, some crazy like outbreak in a movie where half the people who get it end up in the hospital, that's that's not going to happen. The problem though, is we just don't have the capacity that we would need in our hospitals to deal with all these people stick at once. And that's really the point of the measures is to, is to flatten that curve that jump that spike in cases, like if you just picture like you were saying before, how fast but just look at how fast the numbers are changing. And then when you hear about it in the media, the whole goal is to get that to slow down and spread itself out so that the people who do unfortunately get more, who are more sick and need hospitalization have a place that they can go and the resources aren't being taken up by too many people all at the same time.

Scott Benner 41:25
So the basic idea is that we don't, we only have a certain amount of hospital beds, ventilators, things like that. And for people who listen to the podcast, it's actually an interesting overlap, because we talk about stopping rises in blood sugars before they happen. Because if you never get high, then you don't have to deal with the things that come with being high, you know, extra insulin crashing, getting low later. So we're really trying to stop the spike of, of infection, not because we think it's going to stop people from getting sick, but so that it spreads out illnesses over time, so that hospitals can handle people's illnesses, if everybody gets sick at once they'll overwhelm the healthcare system, right, we can spread it out a little bit, then your grandmother gets to go in and get the treatment she needs and come out alive. Instead of ending up in there with four other people's grandmothers. When there's only three ventilators and then they got to do any meenie miney. Mo to find out which grandma doesn't get a ventilator.

Adam Naddelman, MD 42:17
Right. Right. That's I mean, that's exactly what the hope is that you can let the healthcare system catch up, like, I don't know if you saw last couple of days, but some of the governor's now are starting to really ask the military as the federal government to even deploy the military and let them put up a 500 bed, you know, mobile army type hospital that they do all the time. You know, they have a lot of experience over the last 20 years doing this. And it would be incredibly helpful. I mean, there are abandoned warehouses, there are all kinds of buildings, how about taking some of the dorms that no one's living in now, and using them if you need to, there's all kinds of structures that could fulfill this. And that would just give everyone a big sense of relief that they're that, you know, the capacity is there, it's temporary. When we're done with it, you can take it all down. It's when there is a tremendous need for it.

Scott Benner 43:07
I think people think that's crazy. But it seems a little morbid, but my wife's lobby of her building was used as a mortuary during 911. Like the need to take bodies, and they just, they use the building, they did what they had to do,

Adam Naddelman, MD 43:20
right? I mean, this is this, it seems like you know, because I think part of the problem is we have a hard time with the notion of this is likely going to happen. So let's prepare for it versus, oh, no, this is happening, we need to do something now. We tend to be more reactive. And I think the governors are, to their credit to being much more proactive and trying to get ahead of this so that we don't end up in a situation like you're talking about. It's, you know, a lot of those calculations that were being done when people were talking about things like you know, rationing care. That was before all these measures were put into place and they and every study that's been done and every calculation that's been done really does show that even a day or two earlier with these measures can make a huge difference. So we're gonna have to wait and see whether or not it was enough and how and whether or not it was early enough.

Scott Benner 44:14
Yeah, we got we got to a too late by waiting that that that week in there because I know people talk about it as this has been ramping up for a few days. But I think if you really look back, it's been happening for a week or so in America.

Unknown Speaker 44:26
It's been a

Adam Naddelman, MD 44:26
week of, hey, should we be doing something about this? No, don't worry about it. Like that's been about a week. I you know, I was away. Like in the beginning or so of February and I saw in the paper an article about a novel Coronavirus in China. It was like a little blurb like on page, you know, 52 or whatever the newspaper. And I remember thinking like how that's interesting. I wonder if that's anything like SARS or MERS or these other ones. That was like six weeks ago. Yeah. And you think about where like, think about where you this was a week ago, think about two weeks ago. If I told you three weeks ago Hey, guess what in three weeks your son's cancelled, a college canceled kids are home from school all the major sports are canceled. There's nothing on TV for them to watch. It's It's amazing. And that's the worry is are we good? Three weeks from now? Are we gonna look back and go? Yeah, you know, when we were complaining about how we had the kids home from school, that's nothing compared to what's going on at hospitals. Now

Scott Benner 45:21
I got lucky. It was really lucky because I did more traveling this year than I have previously. And I've never been a hand sanitizer person. But I just thought, I've so many commitments, I can't get sick. So I bought one with a little pump. And I put in the door in my car. Every time I got in a you know, I got back in my car from a public place. I gave a little squirt. And I rubbed it around. And I even like thought, like I put it on my cell phone like dirty me like I thought, well, let me see what I can do here for myself. And so you'll find this. I hope you find this funny. But then if you do it with the kids, you know, like when Arden gets in the car, like here, and she rubs it around, and she always goes now I smell like Dr. Edelman.

Adam Naddelman, MD 45:58
That's great.

Scott Benner 46:01
And now I'm thinking looking back, I'm happy. It was random. But I'm happy it happened because I have been in a lot more public places and traveling through now. But I've just been kind of cognizant about it. I've been like, you know, like, I go through places, thoughtfully not touching things. I was on a train the other day, I just thought you know what, let me practice my skateboarding skills here. I'm not going to hold on to the bar, you know, and if I hold on to the bar when I get out of the train a little thing, is that stuff really? Is that just in my head? Or is that stuff valuable?

Adam Naddelman, MD 46:30
No, it's valuable. It definitely is valuable. You know, old fashioned soap and water is just as good. If you're worried that you can't find PRL anywhere. Now, you can't find hand sanitizer anywhere, but it No, there's no doubt that it's valuable. So yeah, I mean, practicing this hygiene all the time. Like even something as little as Hey, before you eat your dinner, Go wash your hands. Like I'm sure we're all saying that to our kids, our our parents did that to us. But you know, just like you said earlier, like you get lacs about it, oh, they're outside, they're having to catch thrown a ball around, they come in, they eat a piece of pizza, they don't always wash their hands. Now, I think people are saying, you got to really wash your hands you got to be good about and you got to really wash them, it's not enough to run them into the water for two seconds and say you washed your hands, you got to wash them with soap and you got to, you know, count to 20 at least, and really take your time and wash your hands. But no, there's definitely a value in what you're talking about. Now, for a while we used we were thinking for a while that people were getting like way overboard with the hand sanitizer and not exploiting their kids ever be exposed to any germs. There's a danger that we're going to go all the way back to that and never let kids that playdates anymore, and we're going to shut all this down. There's a value in your immune system being exposed to a wide variety of things over the course of your lifetime, especially when you're young. So there, there's going to have to at some point be a bit of a pullback from all of this, like when when the world returns to normal. But for now, you can't be too careful with this. If you want to use hand sanitizer, every five minutes, do it if you want to wash your hands 20 to 50 times a day do it.

Scott Benner 48:01
Okay, so let's recap here. And I'm gonna let you get back to life. I think, um, Adam has been talking about this a lot lately. By the way, how did you end up on crisc comos radio show talk. So

Adam Naddelman, MD 48:11
I listened to that show a decent amount just because you know, if I'm driving between offices or running home for lunch, I'll put it on and I just called it there was no nothing more than that. I called in and the guy who picks up the phones, asked me who I was I told him who I was. He said, Oh, that's great. Let me you know, I'll put you through first time I got on. He put me through, like almost right away. And then at the end of the call, Chris Cuomo said, Hey, you know, why don't you call back, you know, each day and kind of let me know what you're seeing and whatever. So I figured today that was Friday, I figured let me just see if I actually can get through I thought maybe there was like a back number. I don't know how, how it works. But I called again today. And it got right there again. So I don't know if they set my my number up now to be able to call through or what but I figured lucky. You know, he's talking about this topic. And he wasn't doing it necessarily from a political angle. It was more from the kind of conversation you and I are having. I figured let me offer a medical perspective because not not one of his callers was someone who was actually dealing with this for real and from the health care side. And it sounded like he appreciate I was on there today for I don't know, eight or nine minutes, I think. Okay,

Scott Benner 49:20
well, one day we'll get you back on here and you can tell people the story of how I called you in the middle of the night and you sat on your computer in your underwear finding a hospital to take art into while she was being bad. Yeah,

Adam Naddelman, MD 49:29
it was Virginia Beach right? What are you doing the beach?

Scott Benner 49:33
Yeah, we're on our way to the wrong hospital. And I heard you clacking away on the keys. And it was it had to be like 130 or two o'clock in the morning and you found a hospital that had a kid some kids dedicated center for for diabetes and that's it

Adam Naddelman, MD 49:48
all those kids they're all the people that were there were people that had trained I think at the Children's Hospital Philadelphia so we remember saying he like I have a feeling this might be a better option than whenever the closest place was at that point. You should Did you like turned around and drove in the other direction? But got there?

Scott Benner 50:02
Yeah, it was really. It was really something a long time ago. But uh, so I, I'm embarrassed that I didn't think of you first I for two weeks I've been like, Who am I gonna get on the show to talk about this if this really needs to be talked about. And then I got I landed coming home from Kohl's baseball thing, and I picked up Facebook and there you are talking to, you know, on on the Cuomo show about I was like, why

Adam Naddelman, MD 50:24
am I not thinking of this? So I really appreciate you doing this because I know you've been slammed, your your practice is going to go to is are you going to go to like, this kind of thing? Are you gonna start Skyping with people to see people. So we actually, about a week ago, when we started to realize where this was heading, we about as fast as we possibly could do anything put in place, the whole plan for starting to do telehealth. And so tomorrow is the morning we're going to have a couple training sessions with the people that we're doing it with. And then our hope is that by the afternoon, if not the afternoon, by definitely by Wednesday morning, we will be offering telehealth appointments for basically anyone who has I mean, we could do it for almost anything at least as a starting point. But especially for the kids who parents are worried. You know, just just like you said before, they're calling the office thing, oh my god, he's congested, he's coughing, he has this, he has that, instead of the nurses trying to just triage it without seeing him, we are going to actually do a virtual visit where we can see them and actually observed the child and talk to the parents and do a whole basically like an office visit, it's a good idea. But do it over the phone? Or do I have to do it on the computer, I genuinely think that

Scott Benner 51:37
you know, a lot of bad is going to come out of this whole thing. But a lot of good is going to come out of it too. We are going to become more agile, but we take care of things, you're going to see a lot of businesses follow suit, and maybe some of them won't go backwards again. Or maybe this is the thing you'll keep

Adam Naddelman, MD 51:52
you know, maybe we're definitely gonna keep it I mean picture like even the example you just gave about that awful night all those years ago, imagine if we had telehealth and you said to me Look at her now like you saw her a few days ago, look at her now what do you think's going on? Like, that would be a very different interaction than a cell phone at one o'clock in the morning. And I think I think you're 100%, right? I mean, look, there are times when we all think the world is changing in a way, and we're never going to get back to where we were, and it's all atrocious and good can come out of it. And I think this is one of those situations, it's just gonna take everybody thinking about it in terms of what can they do for each other and not just about themselves, you have to think about it in terms of your neighbors and your community. And if we do that, and I think businesses like you're saying are clearly going to adapt. And I've been saying for years, what in the world do we have to have all these people traveling all over the place to have these in person meetings? for like an hour that you fly to California for an hour meeting and you fly back? like that just seems so foolish? Now when you look at what people are going through, right? Yeah, I more recently?

Scott Benner 52:53
I do I do a fair amount of traveling to give these talks, right. And I just go about, I talked about how we do things on the podcast with blood sugars and stuff like that. And it's really valuable. And I see that I see the people having sometimes very instant, like significant changes in their health. But recently, someone contacted me and they were like, would you come to Japan? I was like, No, but I'll do it over the computer. And we did it. And it worked great. Yeah, I mean, there was really no difference between me not being there and being there.

Adam Naddelman, MD 53:22
Right. I mean, I could see like, for a live presentation in front of a lot of people, and especially question and answers, that can be a real value in a face to face. But, you know, these these meetings that you have some times where you have to really put yourself out in terms of travel, just to spend a couple hours in the, you know, there are certain industries where the face to face thing is still super important. And I think this was is likely going to change that for a long time. Like you're going to do a lot more of this a lot more skypes a lot more kind of video sessions, where you know, as the technology improves, and everyone's in super high def, and the cameras improved. It's not gonna be that different from sitting around a table if you have five computers set up and you can see everyone's faces.

Scott Benner 54:01
Oh, my daughter did her first day of high school from home today. She said she liked it. Is there a way I can keep doing it like this? A couple hours later, Cole got word from his school. They're going to distance learning for the rest of the semester, which is the rest of this year. And Kelly's working for him for for the foreseeable future.

Adam Naddelman, MD 54:21
Yeah, I'm in the same situation. Dana is now working from home. She's not they're not going in at all. My kids are all doing virtual learning. The boys are doing virtual learning with like, they're using zoom where you literally are watching a lecture and the kids are all on the screen at the same time and they're all participating. I think our kids generation is going to be really good at this. Like they actually in some ways, some of them probably will prefer it and may get more out of it because they can it's more condensed like that their lesson plans are right there. There. It's there's not a lot of like walking around between classes, and they're gonna find they can actually accomplish a lot this way. I think it's interesting when you think about the universities, I would I would it would be interesting to talk to people who are in that line of work. But you have to think that there's a real concern among some of these universities that someone is going to come around with a real good online platform for education. And it's going to cost like a third as much as what people are paying, now, you're going to get a degree that's actually really worthwhile, and you're going to be able to do it from your living room. I mean, there's no doubt that the social aspect of college is probably a bigger piece in some ways than the academic piece. But if you can do it for third the price, and this market,

Scott Benner 55:31
yeah, there's right. There's no reason not to try. So I, I just think it's, you know, it's not dissimilar to I say this about diabetes a lot. And sometimes people think it's odd, but, and I don't, I always say like, don't get me wrong, like I would genuinely do anything for Arden's pancreas to work, right. But because it doesn't, we've also had all of these amazing experiences, and she's become a much more resilient person than I think she would be at 13. So goods come from it, too, you can't ignore the good that comes from it, you can hate the bad, but you don't have to, you don't have to ignore the good stuff that's coming. So

Adam Naddelman, MD 56:06
I agree, I agree. And my office is about as crazy as you could ever imagine anything. Right now, there's no doubt about it that we would be life would be much easier right now for everyone who was working in my office and putting in the hours they're putting in if this wasn't going on, but I also have no doubt that when it's finally over, we will be a better practice and better physicians and better nurses. And more probably empathetic even to people like we will all be a little better. Because we worked through all this. It's hard to see it now because we're not at the end of it yet. But I really do, I really do believe that. But you got to really you got to just work it you got to you got to think about everything that's going on, you got to take the measures that the experts are recommending you got to believe the scientists, you have to you have to really think about what you can do for each other. You got to you know, all of those things, I think are critical for all

Scott Benner 57:01
you people who are always my wife said she heard you saying this earlier today. But I've seen it on Facebook a little bit for everybody's always bemoaning I don't have enough time with my kids. there's now an equal amount of people were thinking and saying out loud in some points. I don't want to be around my

Adam Naddelman, MD 57:14
kids this Oh, it's so true. And I was saying earlier that, you know, for every time you complained about all how to want to go to that practice, I really have to take into this. Now, how many people would you know, pay $1,000 to be able to have their kid just go to softball practice.

Scott Benner 57:29
I told my son tonight I said, you know, it's interesting. We live in a time, unlike any other time in history, so you have so much ability to do so many varying things. And he was home from school for three hours yesterday and told me he was bored.

Adam Naddelman, MD 57:43
They're bored out of their mind.

Scott Benner 57:44
Yeah. I said, I don't know how you're bored. You have a computer in your hand that could watch a space shuttle. You could, you know, I you just maybe you needed to dial in one time to the internet in your life to realize how amazing this is televisions that you have and contact with other people. You can speak to people if you want to face to face and all this stuff. And he's like, I don't know what to do. Like.

Adam Naddelman, MD 58:05
Yeah, I mean, it's amazing. I actually kind of hoped that maybe. And this probably isn't gonna happen. But just simple things, pick up a book, go for a walk, like go for a walk around the neighborhood, just you know, the weather's not bad. Get outside, sit outside for a while with a book like something that's just not the constant incessant, you know, in front of the screen and make you anxious and make you crazy because reading every last thing and hearing every last thing I feel

Scott Benner 58:32
I feel the worst for people who just not in the financial place for this for people who don't have a job that sends you home but just tell you can't come in, but you're not getting paid. That's a hard thing to fathom.

Adam Naddelman, MD 58:41
Oh, it's um, but it's unfathomable. I mean, imagine if you owned a coffee shop, or if you owned a restaurant or, you know, you're you're just an employee that's per diem somewhere or you just you're, you know, an hourly employee that you have no benefits, or I mean, it's just, it's unfathomable to think like what in the world is the certain industries going to do? Right? I mean, imagine being like a pilot, for instance. I mean, those guys aren't flying anywhere now. American Airlines cut 75% of their international flights yesterday,

Scott Benner 59:11
I saw that there's 75% of one of the European airlines just shut down. Yeah, they say they said we have no Scandinavian maybe I'm not sure one of them was just like, we don't have any. There's no call. Right. So you know, we're just not gonna fly planes anymore.

Adam Naddelman, MD 59:26
No, I mean, I agree with you. And I think Unfortunately, that's the next big me on top of the fact that the illnesses are going to pick up you're going to start hearing more and more about companies that are not doing well and employees getting laid off and it's going to be really, it's going to be awful for a while. That's why it has that we have to do these things now to hopefully shorten the duration of this and decrease how painful it does get.

Scott Benner 59:50
Yeah, no, I hope people believe that. Is there anything that I didn't bring up or that you didn't say that you think is important?

Adam Naddelman, MD 59:56
No. I mean, the only thing is I do just want to reiterate the social distancing thing. Think keeping yourself six feet apart, you know, with from people around you, including the kids. So no sleepovers, no birthday parties, this is not a snow day, there's a great post circulating about that too, that I saw. Don't treat this, like, you know, it's snowing, and we're gonna pile 20 kids in my basement and let them all watch a movie, you can't do stuff like that. You just have to stay apart. If you have elderly relatives, the best thing you can do is call them and talk to them, don't go visit them, stay away from them. Just because they're family, it doesn't mean that they might not have it. So you really need to take it seriously. If you are going to visit with people do it outside, you know, be outside be six to 10 feet away. Do it for a brief period of time. And but no contact like no hugs and kisses and all of that that has to stop now going to the bow.

Scott Benner 1:00:47
I'm just a genuflect a little bit. And you said that I I called my mother last night who's 76. And she lives by herself. And I just said, Mom, listen, Kelly and I talked about bringing you up here. But I think you're better off where you are by yourself. Yeah, I'm like, Well, you know, text every day and we'll call and everything but I think just you know, she's like, Oh, my card clubs not meeting anymore. And I was like, Yeah, that's good. I was like, don't do any of that stuff. I say go outside. I said the same thing to her. So it's so what I'm hearing, at least between you and I and you and I think pretty similarly about some things but common sense, right? Just use your common sense and don't get in contact with other people. You can't just decide that people look okay, it's you know, right, you know, you should

Adam Naddelman, MD 1:01:31
prompt exactly right just just and be patient because it's going to take some time this is not going to be over in two days. It's going to take some more time.

Scott Benner 1:01:39
Well listen in a world where social There are apps for dating apps that have never once warn people about like sexually transmitted diseases but those those apps are popping up now I'm hearing and telling people listen that Coronavirus blah blah blah, you know, so so I'm gonna let you go with this. What do you call it? You call it COVID-19 or do you call it the Coronavirus? I mean the medical world is calling it COVID-19 I think when we talk to patients and when I just talk about it with friends I'm always calling it the Coronavirus. I think you know COVID-19 just sounds like it just doesn't sound like a virus. I don't know. It just sounds like something different. COVID-19 is really like what they're calling the illness that people get. I'm using Coronavirus. I don't think the people at Corona are so happy that this is the Coronavirus, but it is what it is you must be out of their mind actually. Okay, so I'm going to um, I'm going to in a number of weeks when there's more to say I'm gonna force you to do this again. Just

Adam Naddelman, MD 1:02:29
you know, I'm happy to do it. I mean, look, this is changing unbelievably fast, like incredibly fast. Just thinking back to where we were a week ago. So I'm happy to do it again. If you think it's useful for you, all your listeners find out.

Scott Benner 1:02:42
So thank you very much.

Adam Naddelman, MD 1:02:43
No problem.

Scott Benner 1:02:46
This episode was recorded on March 16 2020. And Adam will be back if there's more to talk about and I think that there's going to be much more to talk about. huge thank you to Omni pod Dexcom and touched by type one for being fervent and long term sponsors of the Juicebox Podcast I appreciate your dedication to the show. Get yourself an absolutely free no obligation demo of the Omni pod sent to your house right now my Omni pod comm forward slash juice box but the links right there in your show notes. Were the ones you can find at Juicebox podcast.com. Start today with the Dexcom g six continuous glucose monitor by going to dexcom.com forward slash juice box again, where the links that you'll find all over the place. And of course touched by type one.org. Head over there, check them out. They're doing amazing work for people with type one diabetes. And you know what i guess if you're in the central New Jersey area and you're looking for a beautiful pediatric center, Princeton Nassau pediatrics, I've been taking my kids there for a very long time. So okay, everybody, listen. Let's do this together. Right, let's look out for each other like Adam was saying, to be cautious and careful. Let's try to ignore the fact that we don't want to stay in our houses for a couple of weeks. Just do the right thing here. And let's get past this as quickly as possible. And if you absolutely have to go out for any reason financial the buy food, whatever. You know, again, what Adam was telling you, keep your distance from people wash your hands. Let's not get in spitting distance, sneezing distance, will be kissing people you don't know or Come to think of it people you do know don't kiss anybody. You understand what I'm saying? Right? If you touch the handrail and something, try not to touch anything else till you handle yourself. Soap and water. Good, good, good, you know like this really get in between the fingers. I think together we can put an end to this pretty quickly and get life back to normal course. The next episode of the podcast will be out in a couple of days. Jenny Smith and I are going to talk about Sick Day management for respiratory illnesses. You know, like the Coronavirus


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